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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\u2019s costing patients a fortune.<\/p>\n
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\u2019s 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\u2019t get what they want from the insurance pot, they\u2019ll get it from your wallet.<\/p>\n
This isn\u2019t just an Australian problem, it\u2019s 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.<\/p>\n
Chances are, you already sense this. That feeling that you\u2019re just a walking ATM for the medical system? You\u2019re not imagining it. Maybe you\u2019ve struggled to access care when you need it, or perhaps you\u2019ve 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 \u2013 navigating healthcare isn\u2019t like buying groceries.<\/p>\n
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\u2019s not an accident. Confusion is currency at the healthcare checkout.<\/p>\n
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\u201cWhen it comes to healthcare, most people have no idea what things should cost or even who should be paying,\u201d says Margaret Faux in her new consumer focussed book.Credit: Photo: James Brickwood<\/p>\n
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\u2019re paying for and whether the fee is fair or even legal. Right now that\u2019s not happening.<\/p>\n
When a doctor tells a patient they\u2019re allowed to charge a gap fee, most people just accept it. Imagine being charged a $50 \u201cadmin fee\u201d 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\u2019re being charged is not only excessive, it\u2019s prohibited.<\/p>\n
Considers Susan\u2019 story. Susan\u2019s 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. \u201cFive minutes at best,\u201d she said of that consult. But then something really jumped out at her.<\/p>\n
The invoice stated: \u201cSTART 07:00 \u2013 FINISH 10:50\u201d. That\u2019s 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 \u2013 not under anaesthetic with no anaesthetist in sight. At 7.50am, she texted him again: the surgeon still hadn\u2019t arrived. Something wasn\u2019t right.<\/p>\n
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 \u2013 before the surgeon had even arrived?<\/p>\n
She requested her medical records and called the anaesthetist\u2019s billing department. At first, they insisted the invoice was correct. But Susan challenged them: Operating theatres don\u2019t open until 7.30am. She wasn\u2019t wheeled in until after 8am.<\/p>\n
The consultation had been charged separately, so it couldn\u2019t be included in the anaesthetic time. The billing team then claimed the time \u201cincluded the consultation,\u201d but Susan didn\u2019t fall for that. It was a deliberate attempt to confuse her. She calmly pointed out that the consultation was already itemised on the bill \u2013 and it certainly hadn\u2019t 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.<\/p>\n
The anaesthetist\u2019s billing department called back and offered to reduce her bill by $600 \u2013 as a \u201cgesture of goodwill\u201d. They still claimed the bill was correct. It wasn\u2019t. They just knew they\u2019d been caught red-handed and were hoping to quietly make it go away.<\/p>\n
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Faux says patients have the
\nright to know what you\u2019re paying for when you see a doctor or specialist and whether the fee is fair or even legal.Credit: Photo: Janie Barrett<\/p>\n
Susan paid attention. She asked the right questions. She stood up for her rights. And it paid off.<\/p>\n
When experience meets the system<\/p>\n
Maeve\u2019s hair was falling out by the handful. Desperate for answers, she searched for a dermatologist who specialised in hair loss. But appointments were scarce \u2013 most dermatologists had waitlists stretching months and charged $500 or more just for an initial consultation. Maeve thought that was outrageous.<\/p>\n
So when she finally landed a quicker appointment at a more reasonable cost, she felt relieved \u2013 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.<\/p>\n
Here\u2019s where things get interesting. On her first visit, he billed MBS item 104 \u2013 correctly \u2013 for an initial specialist consultation. For every subsequent visit, he billed: Item 30207 \u2013 for the injection (which was performed), and Item 105 \u2013 for a specialist consultation (which wasn\u2019t).<\/p>\n
Item 105 isn\u2019t just a fee for turning up. It requires specific clinical work \u2013 a review, an assessment, or meaningful interaction. Just walking in and injecting someone\u2019s scalp doesn\u2019t qualify. So every time he billed item 105 without doing the required clinical work, he was billing for a service he didn\u2019t provide. In Medicare terms that\u2019s fraud.<\/p>\n
Here\u2019s the kicker: the government has no way of knowing that the service wasn\u2019t done \u2013 because they weren\u2019t there. This is the fatal flaw in an honour system that lacks oversight and transparency. It\u2019s a system built on trust, but there\u2019s no one watching.<\/p>\n
Adding insult to injury, the treatment didn\u2019t 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.<\/p>\n
Your own Medicare records \u2013 are your source of truth. Because here\u2019s 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.<\/p>\n
There are still good healthcare professionals out there \u2013 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.<\/p>\n
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.<\/p>\n