Written by Hannah Twiggs

4 out of 10 people admit to delaying surgery due to fear of unexpected costs

Home > Blog > 4 out of 10 people admit to delaying surgery due to fear of unexpected costs

Hannah Twiggs

Latest data revealing a fivefold increase over six years in the number of people drawing on their super to fund medical procedures is a clear indicator of affordability issues plaguing consumers when it comes to managing their health.

Nearly 1.5 million elective surgeries[1] take place each year through the private health system, equating to more than 4000 surgeries every day around Australia. Worryingly, new research from comparethemarket.com.au reveals that 4 in 10 people (38%) have delayed surgery due to fear of being hit by additional costs.

Even after paying hefty health insurance premiums, nine out of ten Aussies (88%) are still being hit by extra expenses after their procedure. Consumer finance expert, Abigail Koch says that you can limit or avoid these unexpected costs simply by asking the right questions before you go under the knife.

New research from comparethemarket.com.au reveals only 12% of respondents managed to avoid out-of-pocket expenses after they made a claim. One fifth (21%) were out-of-pocket by between $500 and $1,000 after their last hospital procedure and 9% were out-of-pocket by more than $2,000.

The independent survey of 1,000 Australian adults[2] with private health insurance, commissioned by comparethemarket.com.au, also found:

Abigail Koch said: “Australians paid $184 million[3] in out-of-pocket expenses during the third quarter of 2017 alone. This statistic, along with our survey results suggest that many Australians with private cover are unaware that out-of-pocket expenses can largely be avoided or at least reduced by using doctors who have gap cover agreements with their health fund.

“It’s important that anyone going into hospital exercises their right to ‘Informed Financial Consent’ ahead of their surgery  – this means requesting all of the cost information relating to their procedure, including likely out-of-pocket expenses. Even if you are unable to avoid additional expenses altogether, at least by asking the right questions, you won’t be taken by surprise with a big bill when you are in recovery.”

Abigail’s five important questions to ask before having an operation:

  1. How much will your doctors charge for the procedure? Find out if they participate in your health fund’s gap cover scheme. If they do, then there should be no gap or you could face a capped amount. If they’re not in your fund’s gap scheme then perhaps think about asking your GP to recommend another specialist that does, but bear in mind that there will most likely be a wait time and additional cost for another consultation.
  2. Will your doctor invoice your health fund directly? If they do, then great! If not, talk to your health fund about the best way to claim to make the process as quick and smooth as possible.
  3. Will you face any additional out-of-pocket expenses as part of the procedure? This could include things like pacemakers or artificial joints.
  4. Does your health fund have an agreement with your hospital of choice? If they do, then ask if they can confirm that you will not have to pay any out-of-pocket expenses. If they don’t, ask which hospitals they do have an agreement with in your area.
  5. Will you face an excess or co-payment? Many Australians choose to reduce their health insurance premiums by opting to pay an excess and/or co-payment for hospital stays. Ask your fund if this applies to you because you don’t want to be taken by surprise by an unexpected bill from the hospital.

[1] AIHW Admitted patient care 2015-15: Australian hospital statistics (released in 2017)

[2] Conducted by Pureprofile

[3] APRA’S Private Health Insurance Quarterly Statistics: September 2017 – Medical Gap http://www.apra.gov.au/PHI/Publications/Pages/Medical-Gap.aspx

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