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What to do when you have medical bill shock after a visit to the doctor

Have you left the doctor’s office feeling sick and vulnerable, only to discover that the initial consultation fee came with additional costs? You’re not alone, writes Navarone Farrell.

Billshock hurts. Like when you walk into the doctor expecting to pay $200, but walk out with a bill for more than double. It’s an unpleasant experience that can leave you feeling uneasy about the financial side of your healthcare

Australians spent a total of $241.3bn on health goods and services in 2021-22 (the most recent data) according to the Australian Institute for Health and Welfare. That’s $9365 per person, per year – and that figure is going up. 

It’s a lot of money, and it’s a lot of money to shell out when you’re not prepared for it. 

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How does it happen?

Let me share my story. I’m in the process of diagnosing and managing a slightly obscure disorder called temporomandibular joint disorder (TMJ). In short, it causes jaw and facial tension, leading to migraines and other horrible things. So far I’ve seen multiple GPs, dentists and now a few specialists. The latest of which was unable to help me. 

The initial consult was around $200, with about $100 taken care of by Medicare. When I booked the receptionist mentioned that anything additional would cost extra. Of course. 

But when I went to pay, the bill was more than $400. The doctor hadn’t mentioned any extra charges. Shocked, I said, “Sorry, the quote was for a little over $200.” 

The receptionist looked at me like I was silly and calmly explained a camera I had jammed up my nose cost another $200. Ouch on a few levels. 

Before you start in the comment section, yes, I know, these costs are necessary, it’s your health, and you need to care for yourself. 

But what are the guidelines on letting patients know about these costs, and when – because sometimes, sadly, dinner on the table has to take precedence. 

What do the rules say?

The Australian Health Practitioner Regulation Agency (AHPRA), a body that deals with best practices for medicos in the country has strong guidelines on informed consent and financial dealings. The most relevant of these are:

  • Ensure that your patients are informed about your fees and charges in a timely manner to enable them to make an informed decision about whether they want to proceed with consultations and treatment.
  • When referring a patient for investigation, treatment or a procedure, advising the patient that there may be additional costs, which patients may wish to clarify before proceeding. 

The Australian Medical Association (AMA), another peak industry body, has a guide on ‘informed financial consent’, but similar to AHPRA, it puts it on the patient to clarify costs. 

“The AMA is strongly committed to fee and billing transparency and publishes extensive information to support fully informed financial consent between doctors and their patients,” President Professor Steve Robson said.

“The AMA supports and actively encourages full transparency of doctors’ fees and for doctors and patients to discuss fees as early as is practical.”

It does also note there are a range of circumstances where a doctor might find it difficult to provide full informed financial consent i.e. if someone needs emergency care.

The Royal Australian College of General Practitioners said it’s a complex issue for GPs, who won’t know what issue a patient will present with, or what treatments are required until after the examination. 

“A GP can’t know what all the costs involved in an illness will be ahead of time, and in a complex medical investigation, a GP might have to explore several potential issues before a diagnosis. It’s vital to continuously communicate with patients on these kinds of issues,” President Dr Nicole Higgins said.

“Our guidance for GPs and practice staff and position statement emphasises the importance of being transparent about any out-of-pocket costs. 

“Sometimes those may be down to an external service, such as pathology, but with the cost of materials growing faster than Medicare patient rebates, some practices may have to pass those costs onto the patient to keep their doors open.

“The important thing is that GPs and practice staff are comfortable having conversations with patients to prevent bill shock.” 

What can you do if you are in financial strife?

I contacted my specialist, just out of curiosity to find out what their process was after my appointment. They dodged the question and claimed everything was done according to standard. And they’re technically not wrong. 

The onus, according to the AHPRA and AMA, is on the patient to ask. It seems difficult, especially mid-consult, but don’t let that put you off; you’re within your rights to engage the doctor on costs.

Victorian Health Complaints Commissioner, Adjunct Professor Bernice Redley encourages discussion early on in the consultation period and cost transparency.

“It is expected that health consumers are fully informed about any fees or charges and provide consent when making decisions about their health care,” she said.

“Generally, information about fees or charges is provided up-front, and options discussed early in the consultation or at the time when a fee becomes apparent.”

She also said there are options for recourse if you’re unable to pay, or if you believe the complaint should be escalated.

“Patients are encouraged to discuss their concerns, including costs, with their health provider in the first instance,” she said. 

“If their concerns are not addressed to their satisfaction, they can raise a complaint with their provider or the health service. Information about how to make a complaint should be easily accessible at the service or on their website.

“If the patient’s concerns email unresolved, they can escalate their concern to the Health Complaints Commissioner. If the complaint relates to an individual registered health practitioner, they can make a notification to the AHPRA.” 

How can you avoid bill shock?

To avoid bill shock the AMA encourages you to ask the following questions:

  • What are your fees?
  • Are there any fees for other doctors?
  • Will I have any out-of-pocket expenses?
  • Is your fee an estimate only?
  • Can I have an estimate of your fees in writing?
  • If the costs change, when will you let me know?
  • Should I contact my health fund?

As for me, – well I’m just going to have to wear the costs, no matter how badly the situation has gotten up my nose –  but next time at least I’ll be better informed.

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