If you need to see a specialist doctor, understanding your choices and what to expect before your visit, can help you get the most out of the experience.
What’s a specialist?
A medical specialist is a doctor who has completed advanced education and training in a specific area of medicine, such as gynaecology, cardiology or orthopaedic surgery. In fact, there’s specialists for almost all areas of medicine.
How do I see a specialist?
As a public patient, if you need to visit a specialist, you’d usually be referred by your GP to a public clinic, and be assigned a specialist.
If you’re choosing to be a private patient, you’ll generally get a referral from your GP (or local doctor). This referral letter doesn’t need to be made out to a particular specialist, however it does need to be dated, signed and include any relevant information to qualify for a Medicare rebate.
You can learn more about the referral process.
When choosing a specialist, there are a few things you may want to consider. Watch the video below, or keep reading to find out what you might want to consider.
Depending on what’s important to you, you might consider:
- Who your GP recommends
- Experience they may have with your treatment or condition/s, along with outcomes they’ve achieved for their patients
- What hospitals they practice at
- Any recommendations from friends or family who may have needed a similar treatment
- Any costs that they may charge
- Whether they will participate in any medical gap schemes your insurer may have in place?
Your specialist appointment
Prepare for your specialist appointment by making a list of what you want to discuss, including your symptoms and how long you’ve had them, any medication you’re taking (including vitamins and herbal supplements) and any recent medical appointments or treatments. It’s a good idea to find out as much as you can about your family history, too.
Some questions you may want to ask include:
- What is your diagnosis?
- What treatment do they recommend?
- How effective is the recommended treatment?
- Are there any side effects?
- What experience do they have with the treatment, and what outcomes have they delivered when providing the treatment?
- What sort of care will you need at home afterwards?
- What fees will they charge?
Things to take to your appointment:
- Your GP referral letter
- Any test results and/or scans
- Your Medicare card
- Any concession cards
- Your private health insurance card (if you have one)
Can I get a second opinion?
If you decide (for whatever reason) that you’d prefer not to use the specialist you’ve been referred to, or you’re just not sure, you’re entitled to seek a second opinion from another specialist.
If you do want a second opinion, you will need another GP referral for a different specialist. Make sure you speak to your GP about your reasons why you’d like a second opinion, so they can help find the right specialist for you.
What will it cost?
While there are guidelines that give recommendations on how much a doctor could charge, such as the MBS and through the Australian Medical Association (AMA) , specialists can set the fee that they feel is reasonable for their services.
Depending on whether the service is provided before, during, or after a hospital admission, the service may be paid for by:
- Private Health Insurance
- Medicare
- You
- A mix of the above
When choosing your specialist, always remember to ask if they bulk bill or will participate in any medical gap scheme your insurer may have in place, as this may reduce the cost to you.
It’s important to try and ask any doctors and specialists involved in your treatment about any costs you may have to pay, and get it in writing where possible. This is called Informed Financial Consent and will help you avoid any unexpected costs.
The AMA have developed some handy resources on Informed Financial Consent, including downloadable templates that you can give to your specialists to fill out, and a list of questions you might want to ask, which you can access here.
Costs before your hospital treatment
Some of the costs you might encounter in lead up to a hospital admission could include:
- The cost of your specialist consultation
- Costs for tests before your admission. Your specialist may also order a range of different tests in diagnosing your condition, or in the lead up to a hospital admission
By law, private health insurance is only able to pay towards the costs of medical treatment during a hospital admission (also called 'in-patient’ services). Medicare may cover some, or all, of the costs for treatment and tests outside of hospital (also called ‘outpatient’ services).
Costs of your in-hospital treatment
If you’re a public patient in a public hospital, then your costs will be covered by Medicare.
If you’re a private patient in public hospital, or a private patient in a private hospital, then you may have some portion of your costs covered by Medicare, some by your private health insurer and there may also be a gap that you need to pay.
Don’t forget to ask your specialist about this before you have your treatment, so you know what to expect.
How do I know what my private health insurance will cover?
Many health insurance funds have agreements with specialists that outline the maximum amount to charge for each treatment, which limits the amount you’re likely to be out of pocket. This is often called a Medical Gap Scheme.
When choosing your specialist, you can contact your health fund to check if that particular specialist has an arrangement, and if not, it might be worth finding out which specialists they do have arrangements with. You could then ask your GP to refer you to one of these specialists.
It’s important to remember that your specialist can choose whether to use a medical gap scheme on a case by case basis. Check with your specialist if they will for your treatment.
For Bupa customers, you can find out if your chosen specialist participates in the Bupa Medical Gap Scheme by using our Find a Provider tool.
Once you’ve chosen your specialist, you’ll be given an item number (or sometimes multiple item numbers) for your treatment. This number helps your health insurer, and Medicare know exactly what you’re being treated for, and what they will pay toward your treatment.
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