Specialists find their hospital billing practices published online

Medical politics

By Tessa Hoffman

11 Sep 2018

Specialists have had details of their billing practices published online by a major health insurer, after they did not ‘opt out’ when joining its medical gap scheme.

Medibank recently launched a new database containing the details of in-hospital claims made by about 14,000 specialist doctors and other health professionals, searchable by location, which  breaks down the percentage of claims where a health professional charged no out-of-pocket fees, an out-of-pocket of up to $500 or an out-of-pocket of more than $500.

Medibank says customers are concerned when they’re admitted to hospital about how much it will cost, and the Find a Provider online site “enables them to have a conversation with their GP about what their specialist may charge”.

The database lists cardiologists, gastroenterologists, obstetricians-gynaecologists and orthopaedic surgeons as well as allied health and complementary practitioners.

But the publication of billing details has come as a shock to Dr Brinthapan Gunalingam, a cardiologist at St Vincent’s Hospital in Sydney.

He told the limbic he did not recall giving consent to have his billing information published, and he believed the figures attributed to him were incorrect.

“I don’t have a problem with the information being published, but I am a bit annoyed by that,” he said.

GapCover’s terms and conditions state that the company can publish details on participants’ charging practices, however individuals can elect to opt out, a Medibank spokesman said.

“Specialist providers listed on the site have registered with GapCover, have not opted out of being published as a provider, and have made a GapCover claim in the last 12 months.”

The spokesman insisted that billing details attributed to Dr Gunalingam were correct.

Asked to comment on the initiative, Margaret Faux, the CEO of medical billing company Synapse, said the idea was good ‘in principle’ because it improved fee transparency.

“But you have to do it with the doctors onboard, that is the concern. You have to bring doctors with you when introducing these types of initiatives and get their buy in.

“If you do it in a hostile way it will backflip not on doctors, but on the private health insurers.”

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