What Are Doctors Fees?

[Eva]

What does it cost when you see a Doctor on Medicare?

GP? Specialist?

And to see a specialist you first have to be referred by a GP ~ right?

Do you pay the full price and then claim it back?

How does it work?

Feel like a total ignoramus, but I haven't a clue!!

Please can someone fill me in on how it works.....

Thanks

Eva

[Bob]

Any doctor . . . . GP or specialist . . . can charge what he / she likes for a consultation.

Medicare have a 'scheduled fee' for all the usual procedures that we are likely to undergo.

You get 85% back for the cost of the scheduled fee, so if your GP or specialist only charge the same as Medicare's scheduled fee, you will only pay the remaining 15% that you don't get back from Medicare.

Any more that the GP or specialist doctor wishes to charge OVER the scheduled fee set by Medicare is paid solely by the patient.

For instance . . . . . if you go and visit a local GP for 10 mins, they may charge you $40 for visit.

If Medicare has a 10 minute consultation with a GP scheduled at a $30 fee, then Medicare will only pay you back 85% of the scheduled fee (for a 10 min consultation) which is 85% of $30 = $25.50c

If you are charged $40, you will only get back $25.50c from Medicare. The "gap" will not only be the 15% that Medicare don't pay ($4.50c) but also the $10 difference between what the GP charges and what Medicare deems to be a fair fee scheduled for that particular service ($40 - $30 = $10)

. . . . so you are out of pocket for $14.50c if your local GP charges $40 which is $10 over and above the scheduled fee that Medicare will pay 85% on.

It will pay you to find out what your local GP charges. Some charge more than others and Medicare will only give you back 85% of the scheduled fee, so if your doctor charges too much over and above the scheduled fee, it's all at your own expense.

Some doctors deliberately only charge the scheduled fee, in particular for patients on low income or an old age pension, making doctor's fee affordable.

You can pay the full fee at the doctor's surgery as you leave and claim from Medicare at any of their offices around Australia or by posting the claim form which the receptionist in the doctor's surgery will give you after paying the charge.

Alternatively, you can get Medicare to pay the 85% of the scheduled fee and you'll also be billed any outstanding amount owing (the "gap").

You normally have 30 days to pay the amount, if you haven't paid in full on leaving the surgery at the time of consultation.

[Eva]

Thanks Bob!

Is $30 or $40 what GP's actually charge (about) or just an example?

And specialists? What kind of figure is one looking at?

[Mara]

My GP charges $50. When I have seen a specialist for the first time their charges have been between $120 and $180 for a first visit and between $60 and $120 for subsequent follow up visits.

[Karen-in-Brisbane]

OUCH!!

What about PVT medical aid? Do you have cover Mara? Gosh the fees seem rather expensive.

What about medicines??

[Mara]

I have private medical aid, but for hospitalisation only. I have no idea whether or not private medical aids will pay for doctors, I know they do not pay for medicines. Of course, I am only talking about medical aids for citizens and PR, as the medical aid you take out if you are on a 457 will cover everything as you are not eligible for Medicare.

You can of course see a government doctor/specialist for free under Medicare, but for a specialist referral, you can expect to wait. Example.... I suffered badly from nosebleeds. Went to the Austin hospital emergency at night because I could not get a bleed to stop. They referred me to a specialist, made the appointment for me.... to see him a year later! In the meantime I saw a private ENT specialist probably about 4 or 5 times.

As far as medicine is concerned, as long as the medicine you require is on the PBS list, then you have absolutely nothing to worry about, if it is not on the PBS list then you will have to pay for it yourself. In general, most medicines are on the PBS list, it is only newly discovered stuff, that takes a while before it gets on and of course if it is still in the experimental stage and hugely expensive it takes even longer. The PBS list is the list of government approved medication that can be dispensed to people under the Medicare scheme.

[Bob]

"PBS" means the Pharmaceutical Benefits Scheme, which is a part of Medicare that subsidises prescription medicines for Australians.

No matter what the actual cost of a prescription (some being over $100 each!) you will only have to pay $23 for the prescription . . . . . affordable.

You register with Medicare with all the prescriptions you take and the chemist sends Medicare a list of all the prescriptions you've had throughout the calendar year, and once you have paid $450 (at $23 a time, that makes about 20 prescriptions throughout the year), you get the rest for free for the rest of that year.

That way, no matter how sick you are and how many prescriptions you need through the year, you don't have to sell one of your kids into slavery to pay for it all . . . . just a max of $450 for all your needs.

On another matter, before Medicare came into being in Australia in Feb 1984, we had to insure privately for doctor's visits (Medical insurance) and for hospital admissions (Hospital insurance).

When Medicare was introduced, the Labor Party of the day, wanted to scrap all private health insurance just leaving Australians dependent on Medicare for all their health care needs.

However, to get the necessary legislation thro the Upper House (the Senate), the Australian Democrats (a now defunct political party) held the balance of power and negotiated that the only way the Labor Party would win their votes was to allow at least private Hospital insurance for Australians to insure for if they wished.

So . . . . nowadays, we have the compromise situation where you can privately insure for admission to hospitals throughout Australia (hospital insurance), but not insure privately for doctor's visits or specialist visits (Medical insurance)

The ONLY health insurance you can get in Australia, once a permanent resident or citizen, is Hospital insurance for admissions to hospital.

It is illegal for a health insurance fund to privately insure you for doctor's or specialist's visits. That is solely the province of Medicare to look after you.

[polly]

If it takes a year to get an appointment, it isn't very good care....

[zorba]

Hi,

We have private cover with MBF. I recently visited the doctor and the reception staff had NO IDEA how the private insurance works...they kept telling me that I MAY NOT claim for the consultation at all.

So here I am, thinking why on earth are we paying 350pm for medical cover and I can't even claim a consult fee? When I called MBF later they said the difference is that on a Temp Visa it is compulsory to have FULL medical insurance (though no one checks on this), which includes consultations, but that most doctors' offices aren't even aware of this.

They thought I had top up "extras cover" only, but in fact we have OVERSEAS VISITORS COVER, a huge difference in benefits. Phew!

BTW the consult cost $52, but only $19 for medicare patients. And after hours and weekends cost more. Don't get sick!!

zorba

[Bob]

If it takes a year to get an appointment, it isn't very good care....

Whatever condition you may have, there has to be a doctor and / or specialist who will see within a month.

A year is not realistic.

Pick the phone up and ring around for a doctor who will see you this month . . . . not next December!

[Eva]

BTW the consult cost $52, but only $19 for medicare patients. And after hours and weekends cost more. Don't get sick!!

zorba

Thanks. The $19 doesn't sound too bad (converting to rands - I know, shouldn't do that!!) but $52 sounds damn steep!

Fortunately we are a very healthy family! One trip to the Doc this year, to get my son's warts burnt off - and now he's complaining they are growing back!

[Karen-in-Brisbane]

I think we are rather spoilt here with PVT medical care and it is difficult to imagine the set-up in Oz.

It seems very expensive...

Mara/Bob - what does PVT health cover cost for hospital cover? (Say for 3 adults)

Also can you get a repeat script for 6 months like here in SA and how does one get chronic meds??

Do you have to visit a doctor each time?

Thanks for advice.

K

[Mara]

I pay for 100% hospitalisation approximately $200 per month for hubby and myself.

I need to impress on you guys, the fact that they made me wait a year to see the ENT specialist is because they did not regard it as an emergency, if I had been busy dying I would hopefully have seen one immediately.

This is where the difference comes in, as in the case of an emergency they will deal with you straight away, but when it is not regarded as an emergency you go onto their waiting list, which could mean a pretty long wait. PLEASE REMEMBER this is only if you insisit on going to see a specialist under the Medicare system. If you wish to see a private specialist and pay the difference, you see your GP, ask for a referral, call the specialist and make a booking, if it is an emergency your GP is often willing to call him herself and explain to him that she would like him to see you asap.

I have a heart condition, when this was diagosed by the doctor at a private emergency clinic, he sent me to my GP with a letter, when I presented her with the letter she immediately sent me for a scan, they asked me to return to her with the results, she waited for me and immediately made an appointment for me with the heart specialist, whom I saw the next day.... BUT I paid for it all out of my own pocket and then went off to Medicare to get their prescribed refund. Sorry cannot tell you how much it was, this is eight years ago.

[polly]

Thanks Mara. I am asthmatic and this was a worry for me. My system sometimes needs to be quick-started a bit drastically.

[Bob]

I think we are rather spoilt here with PVT medical care and it is difficult to imagine the set-up in Oz.

It seems very expensive...

Mara/Bob - what does PVT health cover cost for hospital cover? (Say for 3 adults)

Also can you get a repeat script for 6 months like here in SA and how does one get chronic meds??

Do you have to visit a doctor each time?

Thanks for advice.

K

As previously outlined, there is no private Medical insurance in Australia for doctor's visits . . . . . only Hospital insurance for hospital stays.

Just mention to the doc when you visit that you need an ongoing prescription so that you don't need to keep running back and forth each time you need the necessary medicine.

The doc should issue you with a repeat prescription that the chemist will accept for a certain period of time (6 months or 1 year)

Medical prescriptions for chronic ailments are catered for by this scheme. The PBS will make sure that you aren't paying excessively for your necessary prescriptions throughout the year. Any more than a certain amount and you get the rest of the year's prescription medicines for free.

http://www.medicareaustralia.gov.au/public...scripts/pbs.jsp

[lyall]

can anyone tell me how much it costs to have a baby in Australia if you got no medical aid and dont belong to medicaire?

...just basic normal delivery..and apologies for asking same type of question, i am confused between public and private hospitals..are there such things as private hospitals here..?

I heard that our local govt hosptial herer in Tasmania is 100 times better than any private hospital in South africa, not talking luxury like gold taps and so on, but medical care-wise.

[kangaroo]

...and what about dental care? Does it work the same - i.e. going to the dentist and claiming back 85% of the dentist's fee from Medicare?

Or should one get private health insurance (when on PR visa) that covers dental expenses in addition to hospitalisation?

Thanks Bob and Mara for all the valuable info so far - much appreciated!

[Jill]

Hi

Went to the Oral Hygenist for a teeth clean this afternoon, $185 and I was there 8 months ago, so my teeth weren't too bad.

OUCH, $185, I would recommend a quick trip to your dentist for a check up and clean before getting on the aeroplane.

Jill

[Mara]

Hi Kangaroo, I have bad news for you there is no medicare cover for dental, unless you are down and out, and then it could take you years on a waiting list to even get a filling.

You can, however, take out private medical cover for dentists. It would cost you approximately $140 for a simple filling and $1000 to have a tooth capped. So it is a case of ouch!

[Eva]

Well, I guess my youngest son will just have to have crooked teeth all his life!!

Talk about expensive!! Maybe one of them should become dentists!

[kangaroo]

You can, however, take out private medical cover for dentists. It would cost you approximately $140 for a simple filling and $1000 to have a tooth capped.

Thank you Mara - seems like private medical cover would be the way to go then for dental too (in addition to private hospitalisation cover). Can you perhaps recommend any specific private medical insurance company that would cater to covering hospitalisation AND dental?...Or are they all more or less similar?

So it is a case of ouch!

Both financially & physically!

[Bob]

..and apologies for asking same type of question, i am confused between public and private hospitals..are there such things as private hospitals here..?

Back before Australia became a country in its own right, we had six different British colonies. Tasmania was one of them. After it grew to a certain size in population, each of the colonies would appeal to the British Colonial Office for self-government, which meant that the colony would have to look after a lot of its own affairs, such as health and education in the colony.

Since the time Tasmania got self government from London, it has been responsible for the health care needs of local Tasmanians. Any of the hospitals at the time, built with money from Britain for the early settlers were administered instead by a local Health Ministry within the new fledgling Tasmanian colonial government.

There have been a number of hospitals in Tasmania, built with Tasmanian State government money for the needs of the people of Tasmania:

Royal Hobart Hospital in Hobart

Launceston General Hospital

Mersey General Hospital in Latrobe

North West General Hospital in Burnie.

These are all public hospitals that I can think of and there are smaller hospitals dotted around Tasmania, in country towns (I can think of one in New Norfolk), that are under the administration of the Tasmanian Dept of Health for the health care needs of Tasmanians.

When the six British colonies federated in 1901, the colonies chose not to surrender all their powers to the new National ("Commonwealth") government. They jealously clung onto their own affairs and only surrendered enough powers needed to the new Commonwealth, such as defence, overseas affairs, immigration, etc.

Tasmania, to this day, still runs its own Health affairs with the Commonwealth subsidising the Tasmanian gov't for this to happen.

If you happen to get crook, you simply rock up at one of these hospitals for admission.

It's free . . . . . all paid for by Medicare.

Medicare is the Australian Commonwealth government's health care scheme for all Australians, and it gives money out to the States and Territories to administer and run their local hospitals.

In the first days of Federation, the colonies became "States" within the Commonwealth of Australia.

They even collected their own income tax and gave out social security payments, such as the dole and Old Age Pensions to their people.

In the middle of the Second World War in 1943, the Commonwealth gov't got all the States to surrender their powers to collect income tax and social security payments as a "temporary" War time measure.

The Australian Commonwealth gov't still, to this day, retains the power to tax income and give out social security payments to all Australians.

That's why income tax isn't different any more from State to State, like it used to be. It is uniform throughout Australia nowadays.

Also, the dole, family allowance, Old Age Pensions, etc, are all the same throughout Australia, as a result.

Tasmania doesn't have the power any longer, since 1943, to levy income tax on its people.

The only way it can get revenue is by local levies (land tax, etc.) and on Petrol Excise and Alcohol Excise, Tobacco Excise, etc.

All these local levies wouldn't be enough to effectively run the State, so the six States and two Territories go once a year for hand out to Canberra.

They thrash out how much each State and Territory gets from the Commonwealth, which collects all the dough from your pay packet and, since 2000, from G.S.T. which you pay 10% for on things you buy or services you get.

That's why Medicare is paid from Canberra to Tasmania in order to run its health scheme and fund public hospitals throughout the State.

There are a few private hospitals around Tasmania:

Calvary Hospital

St Helen's Hospital, both in Hobart

St Luke's Hospital in Launceston

with these hospitals, you pay for admission. They are not run by the Tasmanian government, nor were the hospitals paid for by the public purse. They are private companies.

[Bob]

...and what about dental care? Does it work the same - i.e. going to the dentist and claiming back 85% of the dentist's fee from Medicare?

Or should one get private health insurance (when on PR visa) that covers dental expenses in addition to hospitalisation?

Thanks Bob and Mara for all the valuable info so far - much appreciated!

When Medicare came into being, it was only a "no frills" health care scheme for all Australians, based on the Canadian Medicare model.

Why teeth and eyes weren't included in Medicare, I don't know.

I think they should be . . . . . and always have felt that my choppers were part of my body and overall health needs!

However, till the day our politicians come to realise things the same as me, your eyeballs and choppers won't be subsidised by Medicare.

That's why the smart operators at least take out "Extras" private health insurance, which is not Hospital insurance but covers all the extras in life, such as dental, spectacles, physio, ambulance cover, speech therapy, etc.

Medicare can take care of your basic doctor and hospital needs, if you are reasonably healthy, but taking out private health 'Extras' Cover will just about cover all your own and your family's needs.

I know a lot of Australians who only rely on Medicare . . . . . but do they crack up when they get a bill from their dentist, have some physio done or get new glasses!!!

It's a bit late whingeing about the cost of these things when they are presented with the bill.

The smart operator will think ahead and get "Extras" cover, at the very least, which also attracts the 30% Commonwealth gov't rebate on the insurance premiums to help pay for it all.

My own family have needed braces (both daughters) costing $3 000 each, speech therapy for Kelly( $50 a lesson), glasses for me ($650) and Heidi ($500), chiropractic for Ginnie a fair bit ($70 a time), all our dental costs (I have four crowns @ $1 100 each!) and ambulance for Heidi ($600)

http://www.medibank.com.au/Health-Covers/A...ras-Covers.aspx

There are other private health funds around Australia, but Medibank Private is the national health fund covering all of Australia, so no matter where you live in Australia, or end up, this fund should be a benchmark for you to judge up against the local health funds, if not using Medibank Private.

Edited December 19, 2008 by Bob

[Karen-in-Brisbane]

Thanks Bob and Mara for the helpful and most knowledgeable advice.... and history of how it all began..... Thanks Bob!!! Most informative.

I must say it seems rather " hectic" cost-wise in Oz for medical and dental expenses... I guess it may just be my own impression .... Maybe I need to live it before I can say....

YES PLEASE!!!

mmmmm.... Eva if your son becomes a dentist do we get " SA Rates??"

[Mara]

OK, I went delving a bit and came across a situation where you can claim dental care under Medicare....I have used the option that they describe, but not for dental, I used it to access the services of a podiatrist....worked well! Here is the fact sheet.

http://www.health.gov.au/internet/main/pub...dental-patients

For children I know there is cover for dental for them under Medicare, I am not sure up to what age though, but it is just for simple things like check ups and fillings or extractions, not for braces or implants or crowns..... So yes, you may have to take out a mortgage to pay for braces, should they ever need them.

Another little fact sheet: My husband had to get titanium implants in his bottom jaw, four of them, he was quoted around $25,000-00 in Australia.... he ended up having it done in Auckland NZ for $5500-00....quite a difference I would say. Both of these were private, no Medicare in either country, just a different way of doing it. Also in his instance the NZ way of fitting the implants was less intrusive and 100% better in the long term. So it pays to shop around.