Specialists’ fees cutting deep

2 minute read

Insurers are turning the spotlight on over-charging specialists, and it’s not a pretty sight


Insurers are turning the spotlight on over-charging specialists, and it’s not a pretty sight

Leading health insurers are turning up the heat on overcharging specialists by exposing huge disparities in surgeons’ fees at private hospitals.

Reports from Medibank and BUPA show some specialists command many times what their colleagues charge for the same operation and fees vary widely depending on location.

An analysis of Medibank claims in 2014 shows gastric sleeve procedures had the greatest fee discrepancies among eight operations analysed, with surgeons’ private fees ranging from zero to $6498.

For bowel resections, 56 surgeons who performed at least five procedures charged patients between $13,266 and $49,546 on average, with a median fee of $21,501. Patients’ out-of-pocket costs varied between zero and $1758.

For laparoscopic cholecystectomies, the fee variations swung between $4543 and $21,419, with patients’ out-of-pocket costs ranging from $1166 in NSW to $369 in Tasmania.

Medibank’s Surgical Variance Report also gives insights into hospital-acquired complications, readmissions, prostheses’ costs and length of hospital stay.

Among the gall bladder patients, for example, a hospital-acquired complication was identified in 13% of cases, but in the case of one surgeon the complication rate was 250 per 1000 procedures.

Monash University Professor John McNeil said the large data set, accounting for about 25% of all such procedures in private hospitals in 2014, would help guide better practice.


“Credible data is a powerful motivator of clinician behaviour,” he said. “One of the biggest problems at present is how little data of this type is routinely available.”

A new report from BUPA shows gap fees of $2001 to $5000 were charged for 39% of knee replacements, 25% of hip replacements, and one-third of prostatectomies and breast reductions.

BUPA is developing a digital site to show members typical costs for surgical procedures.

“Making this kind of information available will empower patients and keep a check on the small proportion of specialists who are charging unacceptable amounts,” managing director Dr Dwayne Crombie said.

Private health insurers are demanding more transparency around specialists’ fees and other costs to reduce their burden of claims.

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