Sleep studies costs and gap fees revealed on specialist transparency website

Out of pocket costs for procedures such as sleep studies are now listed on the government’s specialist fee transparency website, but it does not provide data for individual practitioners.

The Medical Costs Transparency website provides broad examples of typical out-of-pocket costs for 62 procedures in 23 areas of practice such as orthopaedics, obstetrics and cardiac procedures.

The website provides examples of low, average and high levels of out of pocket fees that patients can expect to pay for procedures, including areas such as sleep studies, ENT procedures, tonsils adenoids and grommets.

For sleep studies (MBS items 12203, 12204  12205) the website shows that at a national level the average out of pocket fee for privately insured patients is $110 but with 94% of patients having no gap fees.

It provides more in-depth financial information, showing that total doctor fees for the procedure range from $680 (low) through $800 (medium) to $1100 (high), with corresponding ranges in gap fees from $10 to  $250.

The site also shows how out of pocket fees vary between states, with sleep studies likely to incur gap fees of as little as $20 in NSW but as high as $190 in Victoria.

Fee transparency procedures:

  • Assisted reproductive services
  • Breast surgery
  • Cataracts
  • Dialysis
  • Digestive system
  • ENT
  • Endoscopy
  • Gynaecology
  • Cardiac
  • Hernia and appendix
  • Joint reconstructions and replacements
  • Kidney and bladder
  • Male reproductive system
  • Plastic and reconstructive surgery (medically necessary)
  • Pregnancy and birth
  • Skin
  • Sleep studies
  • Tonsils adenoids and grommets
  • Weight loss surgery

In March 2019 Federal Minister for Health Greg Hunt said a website site would be developed to help patients avoid bill shock, with an initial focus on fees for gynaecology, obstetrics and cancer services.

The minister said a national searchable website for information on specialist fees would help tackle excessive out of pocket costs by empowering patients to make informed choices when selecting a doctor.

“Specialists will initially be expected to show their fees as agreed with the medical profession on the website to enable patients and GPs to consider costs when determining their choice of specialists,” said Mr Hunt.

However he added that participation by specialists would be voluntary and some specialists have since commented that they think it unlikely that many doctors will provide information about their individual fees.

The website was described as a disappointing first step by the Consumers Health Forum.

“The Medical Costs Finder website is an inadequate response to the need for an open and comprehensive presentation of individual doctor’s fees and likely out of pocket costs said CEO Leanne Wells.

“But it is a start and we hope just the first step towards a system in which all doctors’ fees are published,” she added.

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