Specialist fees the focus of 'Mind the Gap'

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Gap payments charged by specialists came under significant scrutiny in last night's episode of ABC's Four Corners.

The program, Mind the Gap, was put together based on the billing experiences of hundreds of patients who faced significant out-of-pocket costs through the private health system.

It put the focus squarely on high fees charged by specialists, often many times higher than official rebates set by Medicare and funded by private health insurers, with significant variability across the country.

In NSW, almost 70 percent of people having a hip replacement face an out-of-pocket cost in excess of $2000. This is 40 percent in WA and 25 percent in Victoria. It is zero in South Australia.

The program also highlighted the fact a significant proportion of out-of-pocket costs related to services or consultations provided outside a hospital. Private insurers are legally unable to cover these costs.

It revealed some people had been charged an 'administration' or 'booking' fee of up to $6,000. The fees are unethical and illegal, said Royal Australasian College of Surgeons president John Batten, but are used to circumvent no-gap and known-gap schemes.

Private Healthcare Australia CEO Dr Rachel David said anyone presented with such a fee should ask their doctor for an explanation. She said transparency on out-of-pocket costs was imperative. 

Private Healthcare Australia has called on the government to establish a single agency with responsibility for assisting consumers with complaints about medical bills.

The association also argues fees and charges not associated with a clinically relevant service should be illegal where Medicare is also billed and that the government should act to raise consumer awareness about high medical fees and the fact they are not correlated with the quality of the treatment.