Out of Pocket Fees – A hot topic

Out of pocket fees charged by Specialists continues to be a hot topic in the media in recent times. The ABC Four Corners program conducted a report investigating gap fees being charged by specialists. In addition, The Age ran an article on the 26th May 2018 reporting on the AMA’s National Conference in Canberra recently, with doctors overwhelmingly condemning the practice of some specialists charging exorbitant “out-of-pocket” fees to patients, under the guise of “booking fees” and “bill splitting”.

From our experience working with Specialists, over the past 12 years, we’ve found:

  1. There’s a large range of charges for surgeries, with most specialists charging some form of gap fee within Health fund arrangements or alternatively in reference to the suggested AMA rates.
  2. They all provided Informed Financial Consent, and in most instances where Informed Financial Consent is difficult or impractical, the decision of the practice is to “No-Gap” the patient.
  3. In some instances, practices inadvertently charge the patient the incorrect gap-fee, simply through not understanding the complexities of the Health fund billing arrangements.

If you would like some advice in setting your surgery fees, and educating your staff, to ensure you’re complying with the Health fund rules in relation to Gap Fees, then please call RWS on 1300 073 239.

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