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artme
31st May 2011, 08:10 PM
How many of us bother to check what and how we are charged for some medical services?

Today my wife had some calcification removed from her left shoulder.Before having this done we checked several places run by the same radiology firm to which we were referred.The prices differed quite dramatically, from $350 at one facility down to $174 at the lowest priced facility. This was for exactly the same procedure.

We chose the cheapest facility - partly due to price, partly due to convienence and partly due to timing.

When we went to pay the bill we were asked what was done and were then going to be charged for two separate procedures!! One for the injections and one for the removal of the calcification using a syringe and under the guidance of an ultrasound.


We questioned this and the staff member very graciouslty decided to check with a superior. Often the only response is a fairly assertive "Im' right and you're wrong" type attitude, so this was apleasant surprise.

The charge was the figure we were originally quoted and the Medicare refund was over half the gap.

Now how can this confusion or lack of knowledge arise? The two ladies who dealt with us had a manual that they consulted to find out what to charge. Doesn't this manual exist for all providers/ If it does, why were we quoted different prices for exactly the same procedure/

There are also other anomalies we have encountered in the Medicare system.

On one occasion a procedure that required an overniht stay in hospital could be billed in one of two ways. The first involved an overnight stay to do the first part of the procedure, followed lgater by a second overnight stay to do the second part.All of this would be covered under medicare.
The second option was to have one night in hospital, have everything over and done with in one go. Cheaper? No way! This would have to be a bill entirely footed by us!! Why/ Because it was regarded as two separae procedures.

Only a drongo could think this is reasonable!!

I suggest everyone checks very thoroughly what they are really supposed to pay for anything medical. Save your pocket and save the Medicare bank balance!!!

nick_b00
31st May 2011, 08:36 PM
Why the difference? Because Medicare sets a rebate amount and then any provider has the right to bill whatever they feel their service is worth. Much the same as a builder quotes on his labour and the next builder will rarely quote the exact same amount.

The gap is then your out of pocket - the difference of the practitioners fee less the Medicare rebate. For the same service regardless of the gap, the cost to Medicare (ie us as taxpayers) is exactly the same.

Some items are not covered on Medicare at all and you pay the whole amount. MRI ordered by a non-specialist is one example. In my area the difference is $160-220 total cost with no Medicare rebate.

As an aside at some radiology providers there is a difference in cost between locations too. Eg locally (25km) apart there is a cost difference for one provider that comes to mind for MRI.

On the hospital front, there are some items that cannot be bulk billed ie free to you if done at the same time, Medicare stipulates this in their schedule of items and rebates. So the choice is have all done at once and pay out of pocket cause Medicare won't cover it or have them done completely independently and its covered.

Remember, Medicare isn't about health outcomes it's about cost and a bottom line.

Hope it helps,

Nick

artme
31st May 2011, 10:59 PM
Yes Nick, all that you say is true.

My problem, however, lies in the fact that the same provider - an organization - allows different charges for the same procedure depending on the site at which the procedure is carried out.

In the case of my wife's procedure the cost confusion was solved by the staff when they referred to a manual that appeared to be a copy of a Medicare manual.

There is still no reasonable explanation for paying for two separate procedures that could be done more cheaply as one procedure for Medicare purposes.

It also appears that there is room for interpretation of how costs are structured and the basis for a refund.

For instance a procedure - such the one performed on my wife - apparently has the ablity to be interpreted as two procedures. I know this to be true because it has happened before, although not with the same procedure, and we only discovered this when collecting the rebate.

rsser
13th September 2011, 02:35 PM
LOL.

Talk to your medico about the rebates under the MBS and they'll be slightly only less puzzled than you.

The rules are legion.

artme
22nd September 2011, 10:42 PM
It just keeps happening!!

I went to have an ultrasound on my left shoulder as the GP thought I had the same problem as Ana.

Same place of examination with the US, same firm performing.

Cost? Bloody near twice as much!!!

Result was only a bit of bursitis:C.

munruben
27th September 2011, 08:31 AM
I had a severe pain in my right shoulder a couple of weeks ago and the doc sent me off for an Xray and Ultrasound at their Xray department and it didn't cost me anything.
They diagnosed me with a torn ligament and was told it would be 3 months or more to recover which, in my opinion, was a load of garbage, I was pain free in 2 days. Not a bad recovery from a torn ligament for someone my age I thought.