According to Medicare data, to visit a specialist outside of a hospital in 2017-18, Australians paid an average of $80 out-of-pocket.
While this average provides a good indication, the cost of visiting a specialist varies; influenced by the type of specialist, procedures and tests conducted, the specialist’s status on Medicare, and the patient’s insurance. In some cases, specialist medical care can cost thousands of dollars. This is why understanding costs before booking is an essential step that can save you the headache of unexpectedly large bills. With Smart Referral, you can. There is financial support in Australia including Private Health Insurance and Medicare that can reduce or remove the costs of visiting a specialist. These schemes aim to make expert healthcare more accessible to all.
What is Medicare and the Medicare Benefits Schedule (MBS)?
Medicare is a publicly funded, Government healthcare scheme that allows Australians to access a range of medical services for little to no cost. If you access healthcare services in the public health system, Medicare will subsidise your care. Alternatively, services in the private healthcare system may not be fully subsidised. In this instance, the patient or their private health insurer will pay the outstanding costs. The Medicare Benefits Schedule is the list of medical services subsidised by the Australian Government. It outlines the rebate amount that your healthcare provider can claim from Medicare for providing you with healthcare.
What happens when I am ‘bulk billed’?
Bulk billing’ occurs when a healthcare provider claims the appropriate fee from Medicare and does not require any direct payment from their patient. If bulk billed, a patient can visit their healthcare specialist without any out-of-pocket expense. Many GP clinics offer bulk billed appointments. This accessible healthcare ensures that all Australians can visit their GP without financial stress or barriers. When visiting a specialist, however, it is likely that you will incur a fee and will not be bulk billed. This is why it is important to understand the likely costs before visiting your specialist. When you upload your referral letter to Smart Referral, the consultation fee and Medicare rebate are both revealed before you make an appointment. This transparency allows patients like you to understand all costs before booking and not be surprised when the bill arrives.
What private health insurance options are available in Australia?
Private health insurance is an important financial safety net to have in the event you or your family requires medical care. There are two broad kinds of private health insurance; ‘hospital cover’ if you are admitted to hospital and ‘extras cover’ which allows policyholders to access allied health services at a subsided rate. Allied healthcare includes podiatry, psychology and physiotherapy. It is important to note that policies vary in specifics and your policy may cover different services to your neighbour’s. Private health insurance hospital policies vary in level of cover. Generally, there are four main categories of cover.
- Top cover. This premium level of insurance covers all costs of MBS listed services.
- Medium cover. A step down from top cover, medium cover does not cover some of the MBS listed services. Categories on this level that are not covered include some eye procedures and pregnancy services.
- Basic cover. This tier does not cover a range of services.
- Public cover. Public cover involves visiting specialists in a public hospital setting. Wait times are increased on this level of cover.
What are ‘gap’ and ‘out-of-pocket’ costs?
If your healthcare provider charges a larger fee than the recommended MBS, then you may be required to pay the difference. This is called the ‘gap’ or ‘out-of-pocket’ expense.
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