Doctors are charging some patients based on ‘perceived wealth’, according to NIB


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WOMEN seeking breast reductions are being charged based on perceived wealth, a top health fund says, leading to bills up to 10 times the Government-recommended charge.

Men face a similar rip-off for prostate removal.

In levelling the accusations, insurer NIB has also taken a swipe at the most expensive surgeons and specialists, saying they aren’t necessarily the best.

By the end of the year, NIB — which insures more than one million people — plans to expose overrated medicos by making charges and outcomes public.


“We will start to give patients information about performance so they are not just relying on price as a signal of quality,” NIB CEO Mark Fitzgibbon told News Corp Australia.

“Consumers tend to think the most expensive doctors are the best. There is no evidence to support that.”

The outcomes data will be based on follow-up surveys with patients.

The pricing information, to be published on a NIB-run website called Whitecoat, will also reveal how often doctors lumber patients with out-of-pocket expenses.

Some charge no more than the Medicare Benefits Schedule, or MBS. When that happens, Medicare pays 75 per cent of the bill and the fund covers the rest. For a breast reduction, the MBS fee is $900; for a prostatectomy, $1935.

Insurers recognise the MBS fee can be too low, so offer a higher amount. If the medico agrees, there is no “gap” charge for the patient.


In NIB’s case, for breast reduction the no-gap fee is $1320. It is $2941 for a prostatectomy.

But policyholders have been hit with fees of more than $9500 for breast reduction and over $10,000 for a prostate procedure.

Within four months NIB will be providing patients with data on how often a surgeon sticks to the no-gap price.

That would empower those who face paying over that figure to question why.

When Mr Fitzgibbon was asked why he thought some patients were charge more, he said: “Certainly a doctor’s perception of their wealth would be a factor.”

Australian Medical Association vice president Dr Tony Bartone said while some patients might get a discount based on their perceived inability to pay, no-one paid extra.


“We don’t do an assets and liabilities (assessment) unless they put their Rolls keys on the desk,” Dr Bartone said.

The AMA publishes its own list of suggested charges for surgeries. For a breast reduction it is $4465, according to NIB. That is less than half what some women have had to pay.

Dr Bartone said when patients were charged a multiple of the AMA fee, “that is a cause for concern”.

And he said it was true “price does not equal quality”.

The Royal Australian College of Surgeons declined to comment.

NIB’s ambitious plans for Whitecoat include tailoring it for use by the 3.7 million people insured with Bupa and the one million covered by HBF.

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