Secret cuts…Medibank members could face gap fees of hundreds of dollars for CAT scans after the fund cut its rebates. Picture: Thinkstock Source: ThinkStock
MEDIBANK members have profited on the stock market but if they use their health insurance they’ll now be hundreds of dollars out of pocket as a result of a secret cut to benefits.
Medibank slashed the amount it will pay for X-rays, MRIs and other tests on September 1.
The fund has not informed its members of the policy change in writing and they will only find out when they get the bill or if they ring the fund before they go to hospital.
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“We supply policyholders with written information on what to expect with their hospital visit, when we know they have an upcoming hospital experience,” a Medibank spokeswoman said.
Taking a second look…Medibank conducted a review of pathology and radiology costs and cut benefits. Picture: Eiszele Kim. Source: Supplied
The fund’s stance, ahead of its sensitive listing on the stock exchange this week, might save it money but could be in breach of health fund rules.
A spokesman for Private Health Insurance Ombudsman Samantha Gavel says she “regularly talks about funds informing their members in writing of changes to policies,”.
However, this change may fall outside this provision if it is regarded as a change to a purchaser provider agreement rather than a change to the policy itself.
The nation’s largest health fund says from September 1 it will only pay the Medicare schedule fee for radiology services.
Secret cuts…X-rays and other scans could cost patients more as a result of Medibanks rebate cuts. Picture muratseyit. Source: Supplied
This fee can be up to 30 per cent less than what providers charge.
A review by the fund found pathology and radiology benefit payments were rising well ahead of Medicare Benefits Schedule increases, the fund says.
“In the past we contracted with several large pathology and radiology providers at set fees. Unfortunately, these fees were rising well ahead of the Medicare Benefits Schedule of fees,” Dr Andrew Wilson, Medibank Executive Manager of Provider Networks & Integrated Care.
“If we continued to pay pathology and radiology benefits in line with current trends, we believe it would have an adverse impact on premiums and the affordability of private health insurance,” he said.
The fund concedes “as a result there may be out-of-pocket costs for policyholders”.
For example it says some companies are charging $516 for a CAT scan of the abdomen, Medibank will now be providing its members with a rebate of just $385 leaving them $131 out of pocket.
Australian Medical Association president Associate Professor Brian Owler attacked Medibank over the changes claiming they were only too willing to highlight patient gaps resulting from doctors fees “but not the out of pocket costs they are creating,” he said.
Impossible…AMA President, Associate Professor Brian Owler says doctors can’t get quotes from radiology providers before they order a scan. Picture: Supplied. Source: News Corp Australia
Dr Owler said it was not possible for doctors to inform patients what the gap fees for scans or tests might be because they would not know what fees providers charged.
“It’s impossible to expect the doctor every time they order a test to get quotes on whether a blood test costs x or y or z,” he said.
“We order them on the basis of clinical need, not on the basis of what the out of pocket cost will be for a Medibank patient,” he said.
Consumers Health Forum chief Adam Stankevicius said Medibank was treating its members “like bunnies”.
“It has slugged members with above average premium increases for the past two years yet now members find they will have to cover gap charges that can run into hundreds of dollars for radiology and pathology,” says CHF CEO Adam Stankevicius.
“These are the sort of “surprise” gap charges that Tony Abbott promised to curtail when he was Health Minister.
“This is a disturbing start to Medibank’s new status as a publicly listed company. Medibank should be upfront when it downgrades its cover. After paying for a 6.49 per cent premium rise earlier this year consumers have a right to be warned that their insurance cover is actually shrinking,” he said.
Australian Private Hospital’s Association chief Michael Roff says the Medibank move is “concerning”.
“Anything that funds do to increase gaps undermines the value proposition of private health insurance,” Mr Roff said.
“At the same time as they are entering contracts with hospitals to eliminate medical gaps, here they are increasing gaps as part of a service.