Increased transparency key to keeping out-of-pockets costs down.

GMHBA CEO Mark Valena has supported calls for increased transparency on specialist fees to tackle escalating out-of-pocket costs faced by members and customers, as was highlighted in the Four Corners program on 28 May, 2018.

“Affordability is a key concern for our customers, and while GMHBA is doing everything possible to keep costs lower, the issue of managing out-of-pocket costs requires a whole-of-sector commitment,” Mr Valena said.

“The patient stories brought to light on the Four Corners program could be told by any patient from any health fund in the country, and we are concerned to think that any of our members – or indeed any Australian – can be let down by the system when they are at their most vulnerable.”

Mr Valena said his first and foremost concern was protecting members’ interests and encouraged them to actively take steps to inform themselves before surgery, including:

  • Talk to GMHBA to make sure you are covered for the proposed surgery and hospital accommodation.
  • Visit GMHBA’s website for our “find a provider” tool which lists specialists who use our Gap Cover scheme, and who are more likely to charge either no gap, or a known gap. GMHBA also has a health navigation line which can assist members with understanding how they can get the best out of the Gap Cover scheme and also answer any other health related questions.
  • Talk to your GP.  You can discuss any concerns you have about costs with your GP, so they can assist you to find a specialist that provides good quality care within your budget.
  • When you have consulted a specialist about treatment, ask for an up-front quote which includes all likely out-of-pocket costs, including the specialist themselves, anaesthetist, surgical assistant and diagnostic tests.
  • After surgery, if you have any unexpected charges on the bill, do not pay it until there has been an explanation from your specialist (not a receptionist or practice manager). If you remain unsatisfied with the charge or the explanation, seek advice from your State’s Health Ombudsman.

Mr Valena also stated that health funds do not set specialists’ fees and charges, and that health insurers, including GMHBA, are often blamed for costs that are simply out of their control.

“We work closely and productively with many fine medical specialists and believe that it is only a small minority that is undermining the system,” he said. “But that small minority is enough to weaken the system to the serious detriment of our members and the Australian consumer.”

“We will continue to do what we can to educate our members and remind them that there is no correlation between cost and quality of care, and work with the Federal Government and other stakeholders to address the issue and protect the sustainability of the system, for the benefit of all.”

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