{"id":268504,"date":"2026-02-05T06:19:09","date_gmt":"2026-02-05T06:19:09","guid":{"rendered":"https:\/\/www.newsbeep.com\/nz\/268504\/"},"modified":"2026-02-05T06:19:09","modified_gmt":"2026-02-05T06:19:09","slug":"private-health-insurers-take-aim-at-rising-specialists-fees","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/nz\/268504\/","title":{"rendered":"Private health insurers take aim at rising specialists fees"},"content":{"rendered":"

When Luan Lawrenson-Woods was diagnosed with invasive breast cancer in 2017 she had to become an expert in her treatment, but she did not realise she would have to become a medical billing expert as well.<\/p>\n

But that was the case as the 46-year-old navigated a minefield of specialists, surgeons and allied health professionals and their out-of-pocket costs.<\/p>\n

Just as she was nearing the end of her journey and was going in for a breast reconstruction, she fell into a common pitfall \u2014 an unexpected fee from an assistant surgeon she had not known would be in her operation.<\/p>\n

“It’s a maelstrom that’s added in,” she said.<\/p>\n

“You’re thinking, ‘I don’t want to have to think about this when I’m trying to deal with the fact I might die.'”<\/p>\n

As a private patient, her out-of-pocket costs just for surgeries topped $30,000, not including all her other medical costs.<\/p>\n

Her experience demonstrates the difficulty patients have navigating specialists’ fees, both in their rooms and surgical procedures.<\/p>\n

In the latest salvo between insurers, doctors and private hospitals, Private Healthcare Australia has released the findings of a survey of 4,000 people that found more than half received a larger medical bill than expected.<\/p>\n

The health insurer industry body found specialist fees for in-hospital care jumped 22 per cent in the past three years, with the median hospital out-of-pocket expense now $270.<\/p>\n

Some 2,300 patients surveyed were referred to a specialist, and almost one in three had delayed or cancelled specialist care due to the cost in the past three years.<\/p>\n

\"Private<\/p>\n

Rachel David says some patients delay care because of specialists’ costs.\u00a0 (ABC News: Chris Taylor)<\/p>\n

Private Healthcare Australia chief executive Rachel David said between 2019 and 2024, the number of people going to their specialist for an initial consult fell by 8 per cent.<\/p>\n

It meant specialists had fewer patients and were consequently charging existing patients more.<\/p>\n

“People are delaying care they have been told they need because they are worried about the cost, can’t afford the fees, or cannot find a specialist near home,” she said in a statement.<\/p>\n

The report also found 38 per cent of patients received a bill they were not expecting and 29 per cent were charged illegal ‘administration’ or ‘booking fees’ not visible through Medicare.<\/p>\n

Dr David said the affordability problems were funnelling patients back into the public system or back to their GP.<\/p>\n

“Some of these patients will be people who could not access specialist care earlier to diagnose or manage their condition.”<\/p>\n

Insurers, hospitals and doctors battle it out<\/p>\n

Private health insurers have been under growing pressure as private hospitals close<\/a> around the country amid accusations of misusing market power<\/a> to negotiate unfair contracts to short-change hospitals.<\/p>\n

That is alongside growing consumer concern about value for money<\/a> with private health insurance as insurers make record profits.<\/p>\n

But the industry maintains most out-of-pocket expenses come from specialists’ fees and not hospital costs, with the Australian constitution meaning government has little control over what doctors can charge.<\/p>\n

The ‘phenomenal’ costs of seeing a medical specialist<\/a><\/p>\n

Many patients with complex conditions remain frustrated by out-of-pocket costs for specialist practitioners.<\/p>\n

Private Healthcare Australia is calling for more consumer protections and better use of the rest of the health care workforce so they work to the full scope of their abilities \u2014 something canvassed in the recent government Scope of Practice review.<\/p>\n

More competition among specialists was also needed, the report said, with more help to assist GPs show their patients the full breadth of specialists available and their fees.<\/p>\n

This is expected to be available with updates to the federal government’s Medical Cost Finder website.<\/p>\n

Doctors say rebates have not kept pace<\/p>\n

But doctors maintain the rebates paid by Medicare and private health insurance have not kept pace with health inflation, forcing them to charge out-of-pocket fees.<\/p>\n

“Health care costs are going up and patients are paying more and we know that’s causing patients to delay care,” AMA president Danielle McMullen said.<\/p>\n

She said insurer contracts with preferred provider doctors were also complex, with different insurers rebating different amounts for the same procedure, even on top gold cover.<\/p>\n

\"A<\/p>\n

Danielle McMullen says doctors try to contain costs but negotiations with insurers are complex. (Supplied: AMA)<\/p>\n

The AMA yesterday released a position statement also accusing insurers of abusing market power and using “deceptive and unfair tactics” when it came to negotiations with doctors to become preferred providers \u2014 but the industry said doctors were not forced to be providers.<\/p>\n

It said insurers often used a “take it or leave it” approach when it came to negotiating fees to become preferred providers.<\/p>\n

“Doctors are trying to manage that. If the doctor ends up having to increase their fee by a few dollars [and the insurer walks away], the insurer rebate drops dramatically,” Dr McMullen said.<\/p>\n

“It’s about transparency on all sides and helping boost that understanding.”<\/p>\n

\"Luan<\/p>\n

Luan Lawrenson-Woods is now a women’s health advocate and says more discussion about medical costs is needed.\u00a0 (Supplied)<\/p>\n

Now a women’s health advocate, Ms Lawrenson-Woods said she would like to see more discussion of costs and the challenges patients faced.<\/p>\n

She had silver level private health insurance but it did not cover all the costs, and it was only by chance she had critical illness insurance on a loan that picked up more of her out-of-pocket expenses.<\/p>\n

But she said most people were not so fortunate.<\/p>\n

“It makes me frustrated and incredibly sad,” she said.<\/p>\n","protected":false},"excerpt":{"rendered":"When Luan Lawrenson-Woods was diagnosed with invasive breast cancer in 2017 she had to become an expert in…\n","protected":false},"author":2,"featured_media":268505,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[34],"tags":[109350,4677,152546,134,527,17053,85793,152545,111,139,69,67092,152544],"class_list":{"0":"post-268504","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-healthcare","8":"tag-australian-medical-association","9":"tag-breast-cancer","10":"tag-doctors-fees","11":"tag-health","12":"tag-healthcare","13":"tag-insurance","14":"tag-medical-costs","15":"tag-medical-fees","16":"tag-new-zealand","17":"tag-newzealand","18":"tag-nz","19":"tag-private-health","20":"tag-specialist-costs"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/posts\/268504","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/comments?post=268504"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/posts\/268504\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/media\/268505"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/media?parent=268504"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/categories?post=268504"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/tags?post=268504"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}