Guide to fees and costs
Helping plan for the cost of medical treatment
What to think about when considering your healthcare needs
- Talking to your GP
- Your options for specialist care
- Seeing a private specialist
- Ask about specialist fees and costs
Australians have access to a world class healthcare system through Medicare. Your GP is best placed to support you with your healthcare needs, including if you need to see a specialist.
What we mean by fees and costs
On the Medical Costs Finder website, a medical ‘fee’ refers to the amount charged for a medical service by a general practitioner (GP) or medical specialist.
The amount you must pay for the medical fee is called an ‘out-of-pocket cost’. This also can be called an ‘out-of-pocket’, ‘patient payment’, ‘patient contribution’, or a ‘gap payment’. Fees are set by medical providers.
’Bulk billing’ refers to a system where medical providers may opt to bill Medicare directly for services provided to their patients. If you are ‘bulk billed’ by your provider then you do not have pay any out-of-pocket costs. Bulk billing is a way to make care more accessible and affordable to patients.
See the glossary of terms for more definitions of the terms on the website.
Seeing your GP
There are thousands of GP practices across Australia that allow you to access primary care. A good place to start is the Healthdirect website which helps you find GP practices that operate close to you. You can also use the Healthdirect website to filter for practices that bulk bill.
Before going to your GP, you can call ahead to confirm their operating hours and:
- whether they offer bulk billing
- what potential out-of-pocket costs are
- what Medicare Benefits Scheme (MBS) item numbers are likely to be claimed.
Medicare helps subsidise access to private health care for a range of treatments. Your GP can explain how you may be referred to see a specialist for further treatment.
Getting a referral
Sometimes your GP or another health professional will refer you to a medical specialist or to get follow-up tests. Your GP is usually familiar with different types of specialists.
Specialists set their own fees. Fees can depend on who you see and where they are located. Consider your needs and preferences when it comes to specialist care. This will help you and your GP decide on the best specialist for your needs.
You can also ask for a referral to more than one suitable specialist. This is called an open referral.
Your treatment options
Medical specialist treatments and procedures are provided in both the public and private health systems. Your out-of-pocket cost depends on where and how you are treated.
Public patient in hospital – There are no out-of-pocket costs for treatments for public patients enrolled in Medicare.
Hospital treatment for insured private patients – Patients pay the difference between the doctors’ fees and the combined amount paid by Medicare and their insurer.
Out-of-hospital treatment – Patients pay the difference between the doctors’ fees and any Medicare payment. Out-of-hospital procedures are not generally covered by private health insurance.
Explore your options before referral
Your most important source of information when choosing a specialist is your referring doctor. If the cost of specialist treatment concerns you, talk to your referring doctor about your options before you get a referral.
You can also ask about public hospital clinics and treatment options if cost is an issue.
The private health system can give you more options. This includes choice of doctor, reduced waiting times and more flexibility when planning surgery or other procedures. It may also involve out-of-pocket costs. It is important to be clear about your needs and preferences to understand your options.
Do some research
If you know what treatments or services you need, search the Medical Costs Finder to research typical fees and costs. See indicative specialist fees for some services. Your specialist may recommend a different treatment or service after your initial consultation.
Prioritise your needs and preferences
Field of practice
Not all specialists in the same field provide the same treatments and procedures. Your GP may be able to assist you in finding a specialist who can perform specific procedures or treat specific conditions. Is there more than one specialist like this that your GP can refer you to? Your private health insurer may also be able to provide you with the name of a specialist in the relevant field of practice.
Location
If convenience is important, let your GP know your preferred location to obtain specialist services. Sometimes specialists work in multiple places, but their fees may vary between each location. Your private health insurer may also be able to provide you with advice about relevant specialists practising in your preferred location.
Accessibility
Some specialists may have a shorter waitlist. Call the specialist’s rooms to find out what the expected wait time might be. The medical urgency of your condition can also affect wait times.
Cost
You can discuss cost and options with your GP or with your referred specialist. You can also visit the Medical Costs Finder website to understand typical costs. If you know what treatments or services you need, the specialist’s office can provide you with a specific quote and out-of-pocket costs. If you have private health insurance, ask them about what you are covered for and if there are gap arrangements with specialists and hospitals that can be accessed.
Compatibility
You and your loved ones may prefer a particular communication style over another. Ask your GP if they know how the specialist communicates with their patients – whether they are approachable, willing to explain your health needs and treatment options in a way that makes sense and helps inform your decisions.
Talking about fees and costs upfront can help you plan for what you might have to pay. As a patient, you should know what treatment you will be receiving and approximately how much it should cost. This is called Informed Financial Consent.
Out-of-pocket costs depends on your individual circumstances. This cost could be the same as your medical fee. If Medicare and your private health insurer contribute to your medical fee, your out-of-pocket cost is reduced.
Use our guide to discuss costs with your GP, specialist and private health insurer.
Ask your specialist
You can ask questions about fees and costs beforehand and get more details during your consultation. If you know what treatments or services you need, the specialist’s office may provide you with a specific quote and out-of-pocket costs.
When talking to your specialist, ask them:
- For a written estimate of fees
- If you have to pay any out-of-pocket costs
- If Medicare will cover your treatment and how much they would pay
- If you need hospital treatment, ask whether your specialist has a gap arrangement with your private health insurance and if that reduces your out-of-pocket cost
- If you will need to see other specialists. If so, talk to them about their fees and the costs as well
- If you will need other tests and how much this will cost
- When and how will they charge you. Check whether you pay upfront or if they will bill Medicare and your insurer first
- What Medicare Benefits Scheme (MBS) item numbers are likely to be claimed.
There should be no extra administrative, booking, or hidden costs applied.
Ask your private health insurer
- If your policy covers the likely treatment
- If you have waiting periods
- If you have to pay an excess or co-payment
- How much will they pay
- What gap arrangements they have with specialists and hospitals, and how that affects the amount you pay.
These questions may maximise the value of your private health insurance and reduce your out-of-pocket costs.
Ask the hospital
- What their costs are
- If there are additional costs even if you have private health insurance. This might be for medicines, wound dressings, TV and newspaper access, and post-op outpatient clinics.
Other costs you should plan for
If you are getting treatment as a private patient, it is important to be prepared. Many medical costs are covered by Medicare or private health insurance. However, you may have to pay private healthcare providers or hospital charges in some cases. For example, you may have to pay for:
Hospital treatment as a private patient
Health care provider fees – for treatment or assessment – for example, surgeon, anaesthetist, assistant surgeon, other specialist, diagnostic tests and imaging.
Hospital fees – for example, accommodation, operating theatre, prostheses (devices like plates, screws), medicines, dressings, physiotherapy and other therapies.
Out-of-hospital treatment as a private patient
Treatment fees – for example, GP or specialist appointment, outpatient radiology or other tests, cancer radiation or chemotherapy, physiotherapy, other therapies and medicines.
Start searching now
Search for medical services, specialities or MBS items. View typical fees and costs for available services. Helpful information is available on each page so you can get the most out of this tool.
If you cannot find a service, more services will be added over time.
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