Step 5 - Meet your specialist

Once you have selected a specialist, understand what to expect, and what to ask them about any proposed treatments.

Deciding on Treatment

Choosing Wisely Australia have provided five questions to assist you in getting the right amount of care — not too much and not too little. The answers to these questions can help you decide on the next steps and best course of action.

The 5 Choosing Wisely questions to ask your specialist

Tests may help you and your doctor or other health care provider determine the problem. Treatments, such as medicines, and procedures may help to treat it. Something about costs of tests being outpatient and therefore covered at 85% by Medicare and so PHI cannot fund it.

Will there be side effects to the test or treatment? What are the chances of getting results that aren’t accurate? Could that lead to more testing, additional treatments or another procedure?

Are there alternative options to treatment that could work? Lifestyle changes, such as eating healthier foods or exercising more, can be safe and effective options.

Ask if your condition might get worse — or better — if you don’t have the test, treatment or procedure right away.

Costs can be financial, emotional or a cost of your time. Where there is a cost to the community, is the cost reasonable or is there a cheaper alternative?

Discussing costs with your specialist

In addition to thinking about the care and procedures you may be undertaking, it is important to think about costs associated with them. GMHBA encourages members to have the conversation about costs with their specialist to avoid any bill shock.

  1. 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.
  2. Talk to GMHBA and check your level of cover for any proposed surgery and hospital accommodation.
  3. Use the GMHBA ‘find a medical specialist’ tool which lists specialists who use our Gap Cover scheme, and who are more likely to charge either no gap, or a known gap. This can help you start the conversation about costs with your specialist.
  4. Looking for more information of other options? The GMHBA Health Navigation Line assists members with understanding how they can get the best out of the Gap Cover scheme and also answer any other health related questions or provide referral information.

Go to Step 6: Understand your procedure and the costs involved

Surgeons, anaesthetists, excesses, diagnostics, hospital, medical, and pharmacy costs. It is important for you to understand what you are covered for under your policy, the fees doctors and hospitals may charge for their services and which of these can be paid for under your health insurance.