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Out-of-pocket fees up by 300%, data shows

By Trudie McConnochie Reviewed and updated 17 March 2024

Out-of-pocket fees for elective in-hospital procedures have increased up to 300% in the past five years, says Private Healthcare Australia.   

The private health insurance industry body has released data showing that the median out-of-pocket costs for procedures have surged, with heart angiogram procedures now attracting fees of $200 in 2022-23, compared with $50 in 2017-18. 

Out-of-pocket costs are the difference between what the doctor or hospital charges, and what Medicare and private health insurer combined will pay. This happens when doctors or hospitals charge more than the costs Medicare and health insurers have agreed to pay. 

Colonoscopy out-of-pocket fees have jumped from $200 to $250 in the past five years, while hip replacement surgery fees are now $905, compared with $669 in 2017-18. 

Private Healthcare Australia (PHA) is calling on the government to make sure patients aren’t held liable for out-of-pocket costs that aren’t disclosed upfront before procedures.  

“Australia needs to follow international best practice and introduce tough laws to protect consumers from surprise billing for healthcare services,” says PHA CEO Dr Rachel David.  

Read the full story from Private Healthcare Australia.

Trudie McConnochie
Writer and Researcher

Knowledge is power – that’s the guiding principle behind everything Trudie writes, and it’s a philosophy she brings to her work at healthslips.com.au. By breaking down complex information into easy-to-understand blogs and stories, she aims to empower Australians to make the best choices and an informed decision around private health insurance.

Trudie understands firsthand some of the complexity of private health insurance having moved to Australia from New Zealand and having to navigate a vastly different public healthcare system and health insurance structure.

Trudie holds a Bachelor of Communication Studies (journalism major) from the Auckland University of Technology.

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