I’m a Medicare user with no private health insurance, and was referred to a specialist by my doctor.
The specialist sent me for a series of scans and tests. The results were not good, and this specialist referred me another specialist. The second specialist scheduled immediate surgery.
At this point my total out of pocket expenses were less than $1000, between specialist consultations and scans. I considered myself lucky to live in a country with a good public health system.
The surgery went well. As part of managing my recovery, the second specialist prepared a schedule of regular medical checks for the next several years to monitor for a potential return of the condition. If it did return, we’d need to act quickly, and surgery probably wouldn’t be an option. The specialist explained that public health system would cover 40% of the cost of these consultations, plus 100% of the cost of scans and tests. I would be out of pocket for the rest.
Many months later I went through another battery of tests, fortunately all clear. Then something strange happened. I started getting rejection notices through the mail for my rebate claims for these tests. I was informed only then that referrals from one specialist to another specialist are only valid for six months, and after that the public health system will not contribute to any further costs. To make any further claims I would need a new referral, preferably from a doctor in general practice. Of course, a new referral couldn’t be back dated, so I would have to pay all the costs for the latest round of tests and consultations with my specialist, which was a lot of money.
Nobody had ever explained to me that I would need a new referral. Nobody can explain to me why I would have to go and see a different doctor, who is not involved with my treatment, to get a new referral to see the specialist who performed major surgery on me less than a year ago.
Still, I went to a new doctor and explained the situation to her. She was very understanding and gave me a new referral to the specialist. The public health system paid the full cost of my consultation with her, and is temporarily happy to pay its share of my ongoing care from the specialist on that basis.
Why are there different degrees of trust for different categories of doctors? Are specialists more likely to collude and abuse the system? Why hasn’t anyone noticed that some conditions have long recovery or follow-up periods, sometimes much longer than six months? And why hasn’t anyone noticed that adding another, medically unnecessary, doctor’s visit doesn’t seem likely to reduce the cost of my care?
