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Just as bad behaviour in the banking sector spiralled out of control before the banking royal commission commenced in 2017, bad behaviour in the health sector is out of control and it’s costing patients a fortune.
Have you ever wondered why increasing Medicare rebates never seems to lower your out-of-pocket costs? Or why, even with private health insurance, you still end up paying huge bills when you go to hospital? Here’s the bottom line: When healthcare systems like Medicare start to break down, the cost gets pushed onto the patient. If doctors and others in the system can’t get what they want from the insurance pot, they’ll get it from your wallet.
This isn’t just an Australian problem, it’s a global pattern. The more dysfunctional a health system becomes, the more consumers end up paying. And make no mistake, our system is badly broken.
Chances are, you already sense this. That feeling that you’re just a walking ATM for the medical system? You’re not imagining it. Maybe you’ve struggled to access care when you need it, or perhaps you’ve had to choose between getting treatment and paying other bills. You are not alone. These frustrations have become a regular topic at barbecues and kitchen tables across the country. And no wonder – navigating healthcare isn’t like buying groceries.
At the supermarket prices are clear and if something scans incorrectly at the checkout you notice. But when it comes to healthcare, most people have no idea what things should cost or even who should be paying. That’s not an accident. Confusion is currency at the healthcare checkout.
“When it comes to healthcare, most people have no idea what things should cost or even who should be paying,” says Margaret Faux in her new consumer focussed book.Credit: Photo: James Brickwood
Having worked in the health sector for more than 40 years I can tell you that many people inside the system thrive on your confusion. They exploit the blind trust most of us place in doctors to quietly charge more. Of course, doctors and healthcare professionals deserve to make a living just like everyone else. But you also have the right to know what you’re paying for and whether the fee is fair or even legal. Right now that’s not happening.
When a doctor tells a patient they’re allowed to charge a gap fee, most people just accept it. Imagine being charged a $50 “admin fee” at the supermarket. No one would stand for it. But in healthcare we just pay it because the system is so opaque that we assume it must be legitimate. In reality, much of what you’re being charged is not only excessive, it’s prohibited.
Considers Susan’ story. Susan’s text messages with her husband turned out to be the key to unlocking the truth behind a shocking anaesthetic bill. After surgery, Susan received an invoice from the anaesthetist containing multiple MBS items, including a $48 consultation. “Five minutes at best,” she said of that consult. But then something really jumped out at her.
The invoice stated: “START 07:00 – FINISH 10:50”. That’s 3 hours and 50 minutes of anaesthesia time. The problem, according to Susan, was that she was very much awake at 7am. She was on her trolley, texting her husband – not under anaesthetic with no anaesthetist in sight. At 7.50am, she texted him again: the surgeon still hadn’t arrived. Something wasn’t right.
Susan called the hospital and asked what time her surgery actually started. The answer? 8:09am. So how could her anaesthesia have started over an hour earlier – before the surgeon had even arrived?
She requested her medical records and called the anaesthetist’s billing department. At first, they insisted the invoice was correct. But Susan challenged them: Operating theatres don’t open until 7.30am. She wasn’t wheeled in until after 8am.
The consultation had been charged separately, so it couldn’t be included in the anaesthetic time. The billing team then claimed the time “included the consultation,” but Susan didn’t fall for that. It was a deliberate attempt to confuse her. She calmly pointed out that the consultation was already itemised on the bill – and it certainly hadn’t lasted an hour. Susan stood her ground. She refused to pay and made it clear she had records to prove the billing was inaccurate. And then … victory.
The anaesthetist’s billing department called back and offered to reduce her bill by $600 – as a “gesture of goodwill”. They still claimed the bill was correct. It wasn’t. They just knew they’d been caught red-handed and were hoping to quietly make it go away.
Faux says patients have the
right to know what you’re paying for when you see a doctor or specialist and whether the fee is fair or even legal.Credit: Photo: Janie Barrett
Susan paid attention. She asked the right questions. She stood up for her rights. And it paid off.
When experience meets the system
Maeve’s hair was falling out by the handful. Desperate for answers, she searched for a dermatologist who specialised in hair loss. But appointments were scarce – most dermatologists had waitlists stretching months and charged $500 or more just for an initial consultation. Maeve thought that was outrageous.
So when she finally landed a quicker appointment at a more reasonable cost, she felt relieved – and even a bit grateful. Over the next nine months, Maeve saw the same dermatologist, following the schedule he recommended. Each visit followed the same pattern: She waited in the treatment room, he entered, injected her scalp, and left. No small talk. No examination. No update. Just in, inject, out.
Here’s where things get interesting. On her first visit, he billed MBS item 104 – correctly – for an initial specialist consultation. For every subsequent visit, he billed: Item 30207 – for the injection (which was performed), and Item 105 – for a specialist consultation (which wasn’t).
Item 105 isn’t just a fee for turning up. It requires specific clinical work – a review, an assessment, or meaningful interaction. Just walking in and injecting someone’s scalp doesn’t qualify. So every time he billed item 105 without doing the required clinical work, he was billing for a service he didn’t provide. In Medicare terms that’s fraud.
Here’s the kicker: the government has no way of knowing that the service wasn’t done – because they weren’t there. This is the fatal flaw in an honour system that lacks oversight and transparency. It’s a system built on trust, but there’s no one watching.
Adding insult to injury, the treatment didn’t work. Maeve later found out it was the wrong treatment entirely. She sought a second opinion, saw a new dermatologist and was finally given the correct treatment. Her hair is now growing back.
Your own Medicare records – are your source of truth. Because here’s the good news: Your Medicare records never lie. Just about everything lands there and once you know how to read them, and understand what they mean, you are in control. You have the law in your hands and no one can deny what is on your Medicare records, just like your bank records.
There are still good healthcare professionals out there – ethical, fair and affordable. And there are steps you can take to find them: this book is a patient power guide designed to unconfuse the system.
This is an edited extract from How to Avoid the Medical Bill Rip Off! by Dr Margaret Faux who is a lawyer and has worked in the healthcare system as a nurse and administrator. It was published on Saturday.
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