How should we explain the complexity of Medicare to patients ?


Over the years I have tried various methods of explaining the Medicare system to patients – usually even an abbreviated version is met with a stunned mullet response or here in Canberra very often with a “rich doctor complaining again” response.

Ideally we should get all of our Reception staff to recite the following a patient:
Welcome to our Practice. We charge private fees that can vary between clinics and even within clinics between doctors. These fees are roughly based on recommended fee structures by the Australian Medical Association but are in many case less than these recommended fees and occasionally more. The fees are based on a time and complexity basis and the Australian Government refunds you some of your money based on a very complex coding and billing system that they update several times a year.

Our doctors would prefer to charge you their usual private fee as that is what they have calculated their services are worth. Very often they however would discount their services out of compassion to the patient. This discount can be minor or it can be all the way to the point where they will only charge you the amount that Medicare would be refunding you.

In practice billing can therefore work in one of the following ways:

  1.  You can be charged the full fee up front and take your receipt to a Medicare office and   claim the money back there
  2. You can pay the full amount up front and if you have registered your bank details with Medicare they will refund you within 48 hours
  3. You can pay the full amount up front using any bank card and then use a savings or cheque card to swipe it through the eftpos machine to immediately get the Medicare component back from Medicare – you therefore effectively only pay the gap amount while the doctor pays for the eftpos and other fees.
  4. You can only pay the gap amount. Because Medicare feels that they cannot trust doctors they will however not allow the doctor to directly claim the Medicare component and instead Medicare will send the patient a cheque, made out to the doctor, to the patient’s address. The expectation is that the patient will then forward this cheque on to the doctor. Very often patients neglect to do this but luckily Medicare has decided that they can start trusting doctors once they have owed them money for 90 days so if that cheque has not been banked after 90 days the money will be directly deposited into the doctor’s bank account. That is off course unless the patient has for whatever reason deposited the cheque made out to the doctor into their own account – the bank should not accept the cheques yet they do and Medicare then wants nothing to do with the matter.
  5. The doctor can decide to discount his services by 45-50% and only charge you the Medicare rebate amount. He or she will even do you the favour of directly claiming it from Medicare instead of charging you and making you then claim it back – also known as being bulk billed. Because this last option is such a massive discount the doctor will try and balance this out by either pushing you out as quickly as he can or he may do a careplan or other similar item number to try and inflate the income that he has generated in order to make the visit financially viable. These additional activities will usually have no impact on your medical care
  6. There are some clinics that will charge you an annual amount as a pre-condition to always be bulk billed. This is however not strictly speaking legal so these payments need to be structured as membership fees or some other smoke & mirrors arrangement and the clinics would need to have very powerful political connections otherwise Medicare might come after them for rorting the system

    In an ideal world….

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