A new specialist-fee checklist is set to help patients weigh cost against medical need.
A new consumer guide from the Council of Presidents of Medical Colleges (CPMC) outlines the questions patients should ask about specialist fees and out-of-pocket costs. The council says GPs have a role in raising patients’ awareness.
The ‘Talking to your specialist about costs’ guide, released last week, outlined five principles for discussing specialist fees and choosing treatment.
Average out-of-pocket costs for an initial specialist consultation have risen from $94.72 in 2016 to $158.75 in 2025 – a 67% increase compared with 32% inflation.
Associate Professor Kerin Fielding, current CPMC chair told The Medical Republic the “practical” guideline helped to address the potential power imbalance between patients and specialists and helped patients understand their rights.
“There is [a] significant lack of understanding out there about [specialist] fees,” she said – particularly among patients and families without established medical knowledge.
The two-page guideline, she told TMR, was intended to normalise questions about specialist fees and to bring the medical specialist Professionalism Framework on Ethical Billing and Fee Transparency “back to basics” in language anyone could understand.
The first was patients’ right to a second opinion, which was not always disclosed because it was not explicitly linked to practitioners’ obligations regarding financial or procedural consent, she said.
Patients addressing fee transparency was particularly important, given that GPs did not always know how much the specialists they referred to charged, Professor Fielding said – a reality she attributed to the bulk billing reforms and insufficient remuneration for longer consults.
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Although legislation allowing the government to publish individual specialists’ fees through the Medical Cost Finder passed last month, she questioned when GPs would have the time to help patients identify affordable specialists, given there was no Medicare item number for the work.
“In the current climate, everyone is so busy,” Professor Fielding said.
“For the GP, when are they supposed to find time to look up individual specialists’ fees?”
Her concern extended to access issues with the Medical Cost Finder, which she said may be difficult for culturally and linguistically diverse people and those in rural and remote communities to use.
One practical step, she said, was for GPs to hand patients the CPMC guideline at the point of referral.
Questions well within patients’ rights to ask included the existence of alternative treatments, lower-cost or public options, additional associated costs, extra specialist appointments and tests, the total payable fee, and any rebate from private health insurance or Medicare.
“It really just legitimises any of those questions [patients] want to ask without requiring them to think about questions, particularly in a stressful situation, which can be really difficult,” she said.
Professor Fielding also emphasised the importance of patients, particularly older Australians or those with chronic or severe health conditions, ideally seeing a specialist with a support person to advocate for them.
Patients must be given a written estimate of total fees, including potential out-of-pocket costs, other providers’ charges and payment options, before consenting to any non-urgent medical procedure, according to the guideline.
The guideline read that patients should not feel pressured into procedures they cannot afford and should be encouraged to discuss alternative payment options, including payment plans, bulk billing, or reduced fees.
With the Grattan Institute reporting that almost one million people delay or skip specialist care due to costs each year, “access to healthcare is fundamental to every Australian, and affordability is a crucial aspect of access,” Professor Fielding said.
The council collaborated with the Australian Patient Advocacy Alliance (APAA) to develop the guidelines.
Read the CPMC’s guideline here.
