How to Choose a Specialist

Capability and Experience

Usually your GP will recommend you see a Specialist.

Ask your GP what they know about the Specialist, their manner and their results, ask if he/she knows what the specialist charges.  

Ask the GP to recommend a couple of other Specialists so that you can undertake your own research.

Other sources of advice worth using include:

• Health Funds – Often have lists of Specialists on their websites, see below

• Family & Friends – especially if they work in healthcare

• Hospitals – If you want to go to a particular private hospital you will often find a list of Specialists who are accredited at that hospital on the hospital's web-site.

Likely Out of Pocket Costs

Specialists’ fees are complex. It is very easy to get bamboozled by terminology around Medical Benefits Schedule, and Health Fund rebates (whether No Gap or Known Gap). What matters to you is what you will have to pay for the medical service, this is known as the “Out of Pocket” cost (OOP).  

To know your likely OOP before choosing a Specialist is your right, but it can be  difficult to find. You will need to be persistent,  asking questions in different ways. We suggest a few ways to ask.

Ringing the Specialist’s Office

When ringing the Specialist’s office,  realise that the  secretary will often not be able to be as specific as you would like, there are many variable factors in operations and how they are charged. Make it clear that you are looking for a fair approximation of the OOP, not an exact figure. She will usually want to help, but you may need to ask your questions in a number of different ways.

Step 1:

Tell the secretary about yourself, your name, the name of your referring GP, the procedure the GP thinks you need (or may need) to have, and that you have been given a few Specialists’ names to consider. Say which Health Fund you are a member of, your level of cover if you know it and whether you are a pensioner or Health Care Card holder.

Step 2:

The most important question is:

What is my likely OOP cost for this operation?

If no useful answer:

What does this procedure usually cost your patients OOP?

If the answers refer to PHI fund levels you might have to ask:

Does Doctor ever use No Gap or Known Gap arrangements with PHIs?

If yes:

Does mean there is usually mean there is no OOP?

If yes:

Will that apply to me?

If yes:

Does this mean I will not be asked to pay anything else above the No Gap or Known Gap levels?( eg Booking or other upfront fees, )

You will now probably have a fairly good idea of what you are up for from this Specialist, it’s now time to ask about the rest of the costs:

Step 3:

The Anaesthetist. The Specialist usually chooses which anaesthetist does his/her lists, there will often be more than one anaesthetist that each Specialist uses at some time for different “lists”. The Specialist usually has little say in what the anaesthetist charges, and may not even know.

It is important to  ask:

Will there be an anaesthetist involved?

Can you tell me what his/her charges are likely to be?

Does doctor use some anaesthetists who charge less than others?

Would I be able to get on the operating lists that they do?

Can you give me the anaesthetist’s contact details?

Step 4:

The Assistant:

Will an assistant be required?

Can you tell me what his/her charges are likely to be?

Step 5

Other Costs:

Are there any other routine Out of Pocket charges, eg pathology, X-Ray, ICU doctors, pharmacy, prosthetics?

Step 6

Public hospitals – you may care to ask:

Does the Specialist operate in any public hospitals?