HCF launches tool that calculates procedural costs, names doctors who charge extra


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PRIVATE health customers are confused about what to expect financially from common procedures and are in need of upfront information, new research has found.

HCF’s recent Hospital Patient Experience Survey uncovered patient uncertainty around what to expect during hospital stays, with cost a major cause for concern.

A number of patients experienced bill shock, not knowing in advance the cost of procedures or the make-up of extra charges they might receive. This combined with 60 per cent of respondents not receiving their choice of doctor in public hospitals and only 20 per cent being cared for in a single room, despite being admitted as a private patient, to prompt many to question whether private health insurance was of value at all.

In response, HCF launched a financial calculator and information hub, called ‘Preparing for Hospital’, which aims to arm patients with the information needed to make financially sound decisions in advance.

HCF’s chief benefits officer Cindy Shay said common patient questions were around what a procedure would involve and cost.


“Customers see the doctor’s fee, but not the hospital fee or how much the whole thing would ordinarily be worth,” Cindy Shay, HCF chief benefits officer, said, adding that people do not know how expensive some common procedures can actually be.

“A hip replacement costs an average $29,000. Most people don’t think it costs that much,” she said. “A cardiac pacemaker or defibrillator is $22,000.”

The Preparing for Hospital hub is on the HCF website and features information around more than 25 different procedures, plus an estimated cost calculator with a breakdown of expenses. One example is a knee arthroscopy, which has an average total service cost of $5,041 with 64 per cent paid by HCF and 21 per cent by Medicare. The customer can expect to pay 15 per cent, or $769. The costs are broken down by orthopedic surgeon, anaesthetist, other clinicians, specialist consultations and assistant surgeon.

The site also lists HCF doctors and whether or not they participate in different “gap” schemes. A “no-gap” scheme means the doctor will not charge the patient extra on top of their cover; a “known-gap” scheme means the maximum out-of-pocket a specialist can charge is $500; and finally, “no-agreement” means they do not participate and patients are in for a substantial gap payment.


“This can be as high as $10,000 to $15,000 for orthopedic surgery,” Ms Shay said. “A lot of people are unlikely to change once they’ve seen a specialist; they find it too overwhelming to ask. We want them to know in advance who participates.

“You can ask GPs to refer you to someone who participates and that can make a big difference.”

Recent knee arthroscopy patient Robert Stockham welcomed the innovation, saying he would have liked to have more knowledge before his procedure.

“I had no idea what the costs would be beforehand,” Mr Stockham said. “If you’ve got a reputable health fund and the information you need, at least you’re not going in blind. If they peg you as not knowing, you’re likely to get a subtle surcharge.”

Originally published as Tool could save thousands on hospital costs

Online Source: www.news.com.au

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