Pathology gap fees

Consumers can face large gap payments for pathology, but a public provider may be able to provide a gap-free alternative.
 
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02.How the proposed legislation affects you

  • If taking your referral to a different provider than the one your GP suggests, you should get phone approval from your GP.
  • Legislation has been proposed to formalise full consumer choice of a provider, with this made clear on referral forms.
  • Public and private providers have told CHOICE about problems that can occur with patient choice. Your GP may want a specific provider with expertise in checking a skin tissue sample for cancer, or may want just one provider testing blood for tumour markers so they know for certain that any changes are not being caused by different machines or testing protocols.

The reality? GPs almost never discuss with you the choice of provider, the costs involved and/or your ability to pay. A compromise is consumer choice, but with the option to lock in a provider on specific clinical grounds.

Private providers

They claim to be operating in a challenging commercial environment, must compete with the bulk-billing public sector and bulk bill about 90% of services. While staff and technology costs are rising, Medicare pathology rebates have been static for many years, and are only paid on the three most expensive item numbers on a request form (this is called “coning”); the others must be done at no charge when bulk billed.

In last year’s Federal Budget, the specimen collection fee that the government pays for licensed collection centres was reduced from $14.80 to $5.10. The federal government cited automation efficiencies and operating profit margins of 18.5% to justify Medicare rebate reductions.

Service refusal can happen

Be aware that your GP can overrule your choice of provider.

An employee of the public provider, Western Pathology Cluster in rural NSW, told CHOICE they had received private referral forms where the GP refused permission for the pathology to proceed, insisting instead on a particular private provider being used. This was not for good clinical reasons, but purely because of a pre-existing relationship between the GP and the private provider. It meant the consumer had to pay more for pathology because their GP overruled their choice.

 

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