- Talk about costs early on and explain to the surgeon if the costs aren't affordable for you.
- If your specialist says they're unable to charge you under your health fund's gap scheme, ask if they would accept another health fund's gap scheme.
- If you transfer from one health fund to another, for example, you leave BUPA after the recent changes to their policies, they can't apply waiting periods for differences between medical gap schemes. But be careful to choose a policy that has the same cover level (for example, not one with a higher or lower excess) and covers the treatment you're scheduled for. Also, make sure the new fund has an agreement with the hospital your specialist uses. The CHOICE health insurance finder will help you find the best funds and policies for you. Our score includes a rating on the fund's gap performance.
- Ask for the fees of any other doctors involved, such as an assistant surgeon or anaesthetist. If the specialist doesn't know, ask for the doctors' contact details and call them to find out.
- Ask for a quote in writing.
How to negotiate with your surgeon
Your surgeon can decide on a patient-to-patient basis if they charge you under your health fund's gap agreement.
According to an AMA survey of their members, the vast majority of doctors take their patient's financial situation into account when setting their fee.
This could mean that with the same doctor for the same procedure:
- pensioners and students are fully covered by the health fund.
- full-time workers and self-funded retirees face out-of-pocket costs.
- someone who is assertive and tells the doctor about their financial situation gets charged less than someone who stays silent.
But if you're sick, you may be in no mood to bargain, especially with a surgeon who may soon hold your life in their hands.
"Certainly an assertive consumer should not shy away from negotiating a fee with the surgeon and asking about no-gap arrangements. The reality is that many people don't feel confident and in any event may often be experiencing anxiety because of their condition and the looming operation," explains Leanne Wells, CEO of the Consumers' Health Forum.
This reflected the experience of one CHOICE member, who told us: "I was in great pain and not in a position to seek other opinions or quibble over costs."
But another member had a more positive experience: "The receptionist raised the matter [of costs], and I was pleased to know upfront."
Talk to the receptionist
The Private Health Insurance Ombudsman Michael Manthorpe suggests it might be better to talk to the surgeon's admin staff about costs rather than the surgeon. "The administrative staff at GP and specialist offices are accustomed to discussing fees and waiting times with patients," he says.
The best surgeon can also be the cheapest
Of course, you'd want the best surgeon, not just the cheapest, and the good news is they could be one and the same: "There's no evidence that links higher fees or lower fees to the quality or outcome of the service required by the patient," says Dr John Batten, president and chair of council and executive at the Royal Australasian College of Surgeons.
What about the anaesthetist?
Anaesthetist costs are in addition to surgeons' fees. Read How much will my anaesthesia cost?
to understand anaesthesia bills and gap fees.