MAR001

Hi All,

My wife's GP referred her to an specialist in a hospital nearby, when she made the appointment the receptionist told her that she should pay $300 minimum and maybe more if further test are required. The lady stressed that she can claim her money back through medicare. but I'm wondering if medicare will return the 100% back or what to expect then.

We are still looking for jobs here and we are really tight with money.

Thank you all and I hope you merry christmas and all the best for 2012 and the next ones!!!

MAR

JAMFC

Highly unlikely you will get the total amount back from Medicare - ask the receptionist for an item number and Medicare will be able to tell you what rebate you will get - sometimes the receptionists are able to tell you what you will get back from Medicare.

Merry Christmas to you too!

MAR001

Thank you!

I miss NHS...

kips

You can phone Medicare on 132 011 or visit your nearest Medicare office for the Medicare schedule fees if you want to ensure you get the correct information. Receptionists are notorious for giving out duff info to patients when it comes to Medicare refunds.

Medicare will only pay 75% of the item number's schedule fee which is set by the government - NOT 75% of the total cost.

Specialists can and do charge well over the schedule fee and you can be left with considerable out-of-pocket expenses, especially if further consultations and tests are involved.

There is no limit on what GPs and specialists can charge patients. You are wise to check beforehand what the cost will be to you.

Up until September I worked for Medicare for 3 years, processing claims, and the biggest source of complaints was the amount charged by specialists and the out-of-pocket expenses.

For example for a 104 (initial consultation with a specialist) the Medicare refund is less than $70 but I've handled claims where the charge has been $350. The average charge by a doctor is between $80 and $150.

I've lost count of the number of times customers say:"I was only in with the specialist for 3 minutes. Nice work if you can get it".

In the city I worked in one very popular local obstretician always charged $126.50 for a 105 (follow-up consultation). The Medicare refund is about $35. Other doctors in the area charged $50-$65 for a 105.

The only time you get a higher refund is when you reach your Medicare Safety Net (the safety net level for a person is based on income and out-of-pocket expenses). Then you receive the schedule fee PLUS 80% of your out-of-pocket expenses.

Some doctors might charge you less if you plead poverty. Some give discounts on consultations if you show a Centrelink concession card, which is what poor elderly people do. But very few specialists lower their fees, even if you have a concession card !!!!

I hope to God I never get seriously ill in this country after seeing what doctors, specialists, radiologists and pathologists charge.

fish.01

Hi mar001, you have been referred to a private specialist just like a private specialist in the UK. If you want to be referred to the public system (like the NHS) you must tell your GP at the time of referral. This will then be 100% free. Like the NHS longer waiting times may apply depending on your local hospitals and the speciality you require.

MAR001

a bit confusing to me...

My wife used today the medicare card (like a credit card voucher) with the GP so we didn't pay anything...
When she did the appointment the lady told her about the consultation fee.. I just checked the Hospital online and it appears to be part of the NSW Government (public I guess) and the appointment time is by february 2012..

I did a bit of research (although I am quite lost) and what she will check is cover for something called "Medicare Safety Net" (as described above) which appears to be better at the time of claim the refund.... however, not sure what to claim if our income now is zero and taking into account that because our visa is 175 we are not allowed to enrol in centrelink...

MAR001

In my country of origin is quite straight forward: Public health is there for free but is so sh...ty, that most of the people pay for private practice and take big private insurance (individual or as part of employment benefits).

I also heard that in US, people that don't pay for insurance are literally screwed.

We were entitled to use NHS while we lived in the UK, My wife had her controls there with specialists, she had even one small intervention and I have a treatment and follow ups for an allergy problem in a great hospital in Leicester and I don't remember paying a penny over there.

Thanks god it's nothing too serious.. but what is the benefit for the regular income people here with serious illnesses and how is this system compared to others in worst case scenarios then? . I am not complaining though; I just was to know what to expect and what benefits get the people here through medicare.

Wendy

I've only ever paid for an x-ray and that was because the doctor didn't write 'bulk bill' (ie: free treatment) on the form. I've been to the doctors a LOT since I got here and been referred to various places for various things.

If you get referred to specialists etc, then you should be able to request that the GP referring you sends you public and the treatment should be free, or with only a minimal gap charge.

My friend never asks and she's always paying for things! Makes no sense to me - well for those of us that can't afford to go private anyway (which she can't really!)

MAR001

Thanks for that one, I would be happy to pay private practice or getting a private insurance in the near future if needed, but we are working on getting our jobs first.
This is a case that requires attention and I am afraid I have to find the way to pay as less as possible this time...

Wendy

Yeah absolutely! Hard to pay for things when you don't have the money.

Some GP's bulk bill, just ring around until you find one. Then if you need to be referred ask for that to be bulk billed too

chris and farideh

My daughter was seen by specialist at the hospital recently & we had to pay $240 for her & I think we got $120 back from Medicare but we made sure the consultant send her to bulk billing tests but there is waiting list for those if ur wife doesn't mind waiting for it.

fish.01

You would just go on the free public system if cost was an issue rather than using private specialists. Seriously ill people usually get excellent free health care.

fish.01

It may be a public hospital but the specialist is seeing you as a private patient. The same specialist would probably also see other patients for free who asked to go on the public system just not as quickly.