The Private Health Insurance Ombudsman And Your Health

The Private Health Insurance Ombudsman in Australia is a body set up to deal with complaints health fund members may have about their fund.

Avoiding Unexpected Medical Fees

The Private Health Insurance Ombudsman in Australia is a body set up to deal with complaints health fund members may have about their fund. The organization recommends patients speak to their doctor about fees before receiving medical care. If, for some reason, this is not possible, the body recommends costs and any associated fees are talked about at the first visit.

If a doctor recommends someone be admitted to a hospital as a private patient, the Private Health Insurance Ombudsman has provided a list of questions that patient should be asking.

What are the Medicare Benefit Schedule item numbers for the different procedures I will be receiving and what is the cost for each of these?

Does the doctor have a gap cover scheme agreement with my private health insurance company and will the doctor agree to treat me under this gap agreement?

What out-of-pocket expenses will there be? (Also confirm with your health fund).

Will there be any other doctors treating me? If so, how can I find out what their fees are?

Will the doctor put his or her fees in writing for me? Will I have time to consider this and absorb the information before medical treatment commences?

How will I be billed? How much time will I have to pay?

Once a patient has all this information and a time for treatment is locked in, the Ombudsman suggests the patient contacts their private health insurer and find out what is covered by their policy.

It may also be a good idea to contact Medicare and confirm what will be covered by them.

What If The Bill Is A Lot Bigger Than Expected?

The Private Health Insurance Ombudsman recommends a few steps someone should take if they find themselves with a medical bill a lot pricier than they originally expected.

Be sure you didn’t agree to the costs before treatment began. If you were presented with a list of costs and procedures before treatment commenced and did not speak up, this may be regarded as implicitly agreeing to pay the fees.

Call your doctor’s office and find out why the fees were more expensive than what you first thought.

If you still think you have a case and have been billed unfairly, the Ombudsman recommends you pay at least part of the cost. You could pay the amount you thought all parties had originally agreed on.  Alternatively, you could find out what the recommended fee is on the Medicare Benefits Schedule and pay that cost.

Once you have paid that fee, get in touch with your doctor in writing and state the following:

Tell them the amount you are paying and why you are paying that for now.

Just to confirm, re-state the amount you thought you had to pay and why you thought you had to pay that amount.

Ask if any other treatments had been carried out other than the ones originally agreed on. Also ask if a case can be filed for the unexpected cost.

Explain personal circumstances that may prohibit you from paying the full amount billed.

List any further costs you would like to pay or request a payment plan.

Ask for their response in writing.

If you cannot come to an agreement with your doctor, the government’s Private Health site suggests you get in touch with the health complaints agency in your state or territory. If you received treatment via a private health insurance provider, call the Private Health Insurance Ombudsman.

What If I Can’t Afford The Bill?

Before treatment commences, ask if you can be treated as a public patient in a public hospital. If you have already received medical attention, most doctors would be willing to negotiate their costs. Try to pay as much as you can as soon as possible and get in touch with your doctor’s office to let them know you have done so. Let them know you are in financial hardship and can’t meet the costs of the full bill. There is a good chance the doctor will agree to a payment plan as long as regular payments are kept up. If the doctor is refusing to see eye-to-eye with you, it may be a good idea to contact your local health complaints agency. Find out more about the Private Health Insurance Ombudsman here.