If you have regular pathology tests, here is something you should know
A little back story may be appropriate. In February 2015 I looked at Medicare. It was noticeable that pathology services constituted a large percentage of the total services. I doubt the proportion has dropped since. I contribute to that proportion: I have auto-immune conditions. I spend considerable time and money ensuring they are kept under control. Well, as under control as possible. I’m under the care of three specialists and a general practitioner. Every now and then extra specialists get involved, such as a skin specialist or an ophthalmologist. One of these days I’m going to have a medical party for them all.
As we all know, blood tests are very useful to medical professionals. At one stage I was having regular blood tests under Rule 3X due to the risk of possible rather nasty side effects of a drug I was on. As a patient, I don’t know the finer details of Rule 3X, but I do know it allowed me to have regular tests based on the one pathology request. Necessary in many medical situations and very useful.
At one point in time, early in my “what is wrong” phase, I happened to have medical appointments scheduled in the same week with different specialists. The week before the appointments I went into the pathology collection point with two pathology requests. I later received an invoice for one of the tests. At the time, I paid little attention. I knew my gastroenterologist had ordered a non-rebateable test at some point so assumed it was that and just paid it. As you do, in most cases.
Some time later I again had coinciding appointments and again attended the collection point with two pathology requests. All my specialists monitor my thyroid function. I was told if I had the two pathology requests done on the same day, one would not be bulk-billed. Naturally, I asked why not. Surely, I suggested, only one test was needed and then the result could simply be shared. Same blood, same day, same test. Seemed logical to me. More than that, it seemed cost-effective.
The technician was only able to advise those were the directions from head office, but she believed Medicare wouldn’t pay a second rebate on the same day. Neither should Medicare pay two rebates for the same test on the same day, I thought to myself. By this stage I had been made redundant, so time was really not a major issue, however money was, so I went on two different days to have the blood tests.
When I saw one of my specialists, I mentioned the situation to him. He was in such a state of disbelief, he called a contact within the pathology company. The conversation went something like this:
Specialist: Explains what I have described above and asks if this is correct.
Pathology: “How do you know that?”
Specialist: “Because a patient is sitting in my office telling me!”
My explanation was confirmed by the contact. However, if the specialist hand-wrote a lengthy instruction on the pathology request to share the results of duplicated requests, then they (the pathology company) would do it. My specialist, dear caring man that he is, was sure this was because they were caring for the patients, to ensure the right doctors got the right results. Rubbish, I countered, the rebates are their revenue stream. It was a light-bulb moment for the doctor. That, I said, is why I am the accountant and you are the doctor!
For a few months my appointments didn’t coincide so I really didn’t worry about it. Then the week before last, I got hammered. Now I am working and studying and driving a lot. In what little time remains I sleep, exercise – or visit doctors. As it happened, I had all three appointments close together and the way my schedule went that week I had one opportunity to get the blood tests done. Three pathology requests. Thyroid function on all three, plus some other duplicates.
I was warned I would get billed for the thyroid function test TWICE and some others singly. Wouldn’t I prefer to come back tomorrow and the next day? That is, get the three requests done on three consecutive days so all the tests could be bulk-billed. No, I wouldn’t prefer that at all, I simply do not have the time, was my somewhat irritated response. Of course the aforementioned lengthy handwritten share request was not written on any of the forms this time. Not my doctors’ fault, they shouldn’t have to do that in the first place. So I’ll be paying.
I discussed the situation with my other two specialists. One was aware of the practice and our discussions I shall keep confidential. The other crossed some tests off the new form he gave me for my next visit. We are all going to co-ordinate and share a little better!
Without the operational and administrative cost details I can’t be sure, but I propose running the test once and sharing the results would be cheaper than running the test three times and generating an invoice (maybe two invoices) to me. The company may be “protecting” the revenue stream (Medicare rebates) without looking at the impact of actions on gross margin. Of course, it is a fair bet I am billed more than the Medicare rebate. When I receive the invoices I will compare.
I am told not all pathology companies operate this way, something I am going to put to the test in the coming months. After all, like many other patients, I have years ahead of me to investigate this issue! I would be interested to hear of others’ experiences.
Do you think changes should be made to the system? My specialists should not have to have a conference call to check each others’ test plans: imagine if they had to do that for many patients? I should not have to go on three separate days to have my blood tests. I specifically try to get my appointments all on the same day as this minimises disruption to other parts of my life and time off work. Consequently I am trying to have my blood tests in one hit. When it works out: if one condition flares or requires closer monitoring for a period of time, then my plans don’t work out and then the whole duplication of bloods isn’t a problem. At the moment, with everything running smoothly and in what I call “management mode” I can co-ordinate. Many other patients I am sure are in the exact same situation.
The taxpayer should not have to pay rebates for the exact same test to be performed three times on the same day. Nor should the patient.
23 comments
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cassrs -
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shonias -
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Robyn Dunphy -
abbienoiraude -
Annie B -
Jennifer Meyer-Smith -
Annie B -
Annie B -
Jennifer Meyer-Smith -
wam -
Annie B -
Carmen -
abbienoiraude -
Michael Taylor -
Annie B -
Freethinker -
Marty -
Annie B -
abbienoiraude -
Susan
Return to home pageThis reminded me of an article by Ross Gittins that referred to pathology tests: http://www.rossgittins.com/2016/07/who-really-wins-from-mediscare.html
I get my blood tests done at Laverty. As you know I have a lot of them too. I tell my GP of the specialist appointments coming up and he types in the tests I need done for either or both specialists and ‘copy to’ and ‘copy to’. They all get a copy of the result. Only once in many years did they miss one specialist who should have received a copy. Didn’t realise there could be a problem with blood test sharing.
I have had the exact same thing happen to me. You have explained exactly why common sense doesn’t prevail for multiple requests… They just want the money. The other issue I’ve had is the distribution of copies. Now it is mostly all done electronically, there should be no reason whatsoever that we as patients can’t request copies of our results to go to whomever we please. I have attempted to set up a permanent distribution schedule for all my doctors and so far, it has been firmly resisted, as has the possibility of results being forwarded to me personally as well.
I have had a number of doctors ask for the results to be copied to me personally, which seems the simplest way to manage the sharing. And you know, should probably be routine for everyone, but especially people managing chronic illness across multiple doctors.
Hear, hear Robyn. Talking about rebates-gouging!
You should be considered the owner of the information which you then can present to each of the specialists who need that information.
That way, you won’t be inconvenienced by multiple appointments and it would be more health-cost effective.
My doctors all tend to print out the results for me so I can share (when I remember to do so) – and we are now writing the other specialists in the “copy to” box rather than just the GP.
@Shonias – good idea and something I will aim for!
@Emmee Bee – I can safely say my doctors were not happy with the whole thing.
@Ozbrays2 – there isn’t a problem as such with sharing results – but unless everyone realises there is this issue, no-one goes through the administrative work writing all the extra names on the form in the first place.
@cassrs – I just quickly scanned that article, will read in depth later.
@Jen – That’s why I like the on-line system that nothing is happening to! Then I can own my data and share as and when I please. Even so, the fact is I am given the pathology requests up to six months in advance – yes, the doctors are monitoring some aspects which my conditions have in common, but they don’t all individually know the management regime of the other specialists. The patient becomes the “secretary” for their health – not that there is anything wrong with that, but it would be nice for the pathology provider to be supportive, not obstructive.
Thank you for writing this article.
Husband has an auto immune disorder and has at least three specialists and one GP with additional specialists as required.
We ( that is ME) have to keep our wits about us and make sure the GP or Specialist etc ‘copy to’ all the others so they can keep a handle on where his blood tests are up to. We ( I consider it my disease as well since I have been his carer for over 25 years) have to know who is involved, who needs a copy, what part of the test needs to be shared and make sure before we leave any surgery that the ‘others’ have been included.
I always say; This being on DSP is a full time job for the number of hoops and jumps you have to negotiate must be kept a close eye on as the ‘co payment’ of some specialists can leave us financially embarrassed if we have to see them close together.
When we visit specialists we ask (well hubby won’t as he finds it embarrassing so that is when I come in again) about ‘extra’ payments ( gap between medicare and their costs) as well as extra blood, urine, xray, scope or auxillary tests required, what are the time frames for them etc. Most of the time we on Centrelink can’t get into a specialist when we want anyway…so the wait is usually around 3 months ( even for our GP) in Regional NSW. We have not much say in many parts of his appointments schedules so have to juggle it all.
This is a full time job, keeping on top of all the requirements as well as the changes each time a Conservative Govt comes in and wants to ‘punish’ we on DSP.
The last specialist we visited was 260klms away. HE changed the appointment which was very inconvenient but we had no choice. At least he was thoughtful enough to ( for the first time ever!) bulk billed us!! We nearly fell over!
Thanks again and will make sure new or doubling of tests does not mean a cost to us as it may mean we have to pick and choose my husbands ‘management’ choices of his health providers.
(We have a pathologist who we have been visiting for 25 years and they will take several ‘similar’ requests, combine them and then send them to all medical practicioners named. So far so good, but we are aware anytime it can change in a blink of an eye.)
Agree with your post and statements therein, Robyn ….
My doctors ( GP’s to begin with ) … always cc. results to other doctors ( specialists ) but I usually have to remind them to do that … the specialists sometimes will not. Depends on the specialist I think, and how important they think they are … there’s some awkward bods out there, who don’t find it necessary to send copies to someone as lowly as a GP…. which sucks. At least that has been my experience on several occasions over the years.
I don’t have the problem, as I am retired and can go on different days for blood tests – which I do … although it is a real drag, especially if one or more are ‘fasting’ tests. …. But I certainly can see the problem and why it is happening. … No path. lab will give written test results to the patient, at least not in my experience. However, all GP’s I have dealt with will print out the results for me…. I like to keep lab. notes for myself.
The labs. will however, give out copies of CT, ultra-sounds, MRI, and X-Rays’ – without the notes. THEN expect a patient to turn up WITH the last lot of photo tests, so’s they can compare them ? I do that when I can ( read, if I remember to ) !!
There seems to be an ‘across the board’ type of thinking in the medical profession at times. … e.g. – I am not permitted to take anti-inflammatories, because of a medical condition I have. …. They would be dangerous for me. So I rely on panadeine, mersyndol ( for night time meds ) and occasionally stronger pain meds. under prescription, like panadiene forte or endone.
A chemist will not sell – over the counter drugs on the same day – e.g. panadeine AND mersyndol.
So – one has to sneak off like a thief and go to another chemist to get the 2nd over the counter meds, because one has almost run out of both at the same time. … Nowadays, I buy one, even if I have enough left of it, so’s I don’t get caught this way, and then after a week or so, the other. As for the prescription pain-killer – the chemist again, usually will not dispense another otc pain killer on that same day. …. I don’t think there is a monetary consideration here – just rules and regulations. …. But I add that for readers’ information.
Jennifer MS … is correct. … tests information belongs to the patient, although private notes by doctors do not. ……. Doctors usually send ALL patients’ written history ( by them ) to other doctors, in the event of changing doctors because of location or whatever, – but that is NOT given to patients. … That protects the doctors … and I guess, is understandable.
Good luck Robyn, in finding a way to resolve the situations you have raised.
Might I humbly ask,
does anybody believe Labor will resolve this basic set of human rights once Labor and its allies are in power again?
Abbie ( please read ) ….
Your comment ” Most of the time we on Centrelink can’t get into a specialist when we want anyway -so the wait is usually around 3 months ( even for our GP) in Regional NSW. “
I do NOT understand why that would happen. …. Is it because you are in rural NSW, and are very far away from cities that service the urban communites ? and even far enough removed from the nearest GP ?
It does not make sense to me ( no offense intended Abbie ) … that ANY GP or specialist would deny you the right to their services — especially since your husband is in so much need. ….. 3 months ? …. that is outrageous.
I am a pensioner and rely on Centrelink and the equitable services that can be provided, through them.
Live in a rural area, although only just – it is 8 minutes drive to hit the delineated suburbs of outer eastern Melbourne. … 3 years back, copious amounts of blood from the bladder. GP referred me to a specialist urologist, attached to the hospital 5 minutes from here. The team of specialists ‘roam’ ( for want of a better word ) around the Eastern areas for Eastern Health, servicing hospitals and people on disabiity / pensions / unemployed etc. Saw the 1st one inside a week – the 2nd one 1 week later with 3 other urine samples, and 2 weeks further on, booked into the Angliss Hospital for a cystoscopy by a specialist surgeon. 4 weeks to get looked at, surgically inspected, and the result was – no cancer ( thank heaven ). ( the first urologist thought 90% it would be 🙁 grrr ). … It was considered high priority.
********
Here, there is also a service, for various extra-curricular needs ( podiatrist, chiropodist, physiotherapist, a series of breathing exercises at the local hospital for compromised lungs, and several others ) …. 4, sometimes 5 appointments ( depending on the service offered ) …… FOR FREE. Once all used up, they are then not available again until the following 12 months. It is all on a form signed by a local GP. Can’t recall what the form is called.
I do know that some specialists ( privately referred ) charge like wounded bulls, over and above the bulk-billing. … Cardiologist – 6 years back now, got into my personal account for the sum of over $330 extra … for the little he ultimately did. …. All smiles and not a smidgin of compassion in him. NEVER again – him. … My own ( now ) GP clinic, has specialists visit on specific days – and all bulk bill, as my GP does.
I am not being a smart arse with the above comments ….. but I would urge you to see if you can find out EXACTLY what it is you are being provided with – and not, what you are entitled to, and specifically who is making the decisions on this for you … it sounds absolutely bloody shocking.
Good luck with it all, I know it has been a totally harrowing time for you.
Jennifer … I must admit, I have not had to test the waters ( thank heaven ) since the cystoscopy, … but that was during the new reign of the LNP. … Presumably they had not caught up with it all then. However, the free services as mentioned are still available. …. and I do have 6 monthly blood tests and others if deemed necessary, which does not cost me a cent. …. I ask for, and get – a referral to Melbourne Pathology, who I prefer above all others.
And I have not had to pay one cent of co-pay of any description – or above bulk billing, since LNP have been in power, not for lab tests, path or imaging tests. I have no idea if a person working, can claim such a thing – I am on the Aged Pension. I do however, hold my breath as to when it might / will all change.
Labor offered much more when they were in power – and I believe ( hope ) they would do the same again. I am horrified to think that the LNP will gradually snip away at what is currently available, which it would seem they are gradually doing. Labor provided a $4000 dental referral ( to dentist from doctor ), for people on DSP, Aged, Veteran Affairs …. that was removed, but can’t recall whether by Labor – or by the new LNP government. … I took advantage of that, but was none too pleased with the outcome – but that’s another story.
……….
Abbie,
is there a Health Ombudsman? Or what about the AMA? Going above the practitioners’ heads might get action.
A big plus for darwin our blood tests centres open about half past 7 before work so no probs. But podiatry decreed medicare a no go area and charge the full $90 so i have to go to medicare to get the rebate. That is a big hit and medicare is pretty prompt with rebate but if there is a query or delay that is about 25% of the pension gone. Why????
Found one for NSW, Jennifer, Robyn and Abbie ( and all ).
https://www.ombo.nsw.gov.au/complaints/links
then go to : National Health Practitioner Ombudsman and Privacy Commissioner … listed as a link.
…. there are a few that would most likely be applicable in the lists.
Good luck.
I worked in a major public hospital in Sydney for a specialist who always got 3 to 4 copies of blood results he ordered for his patients, which he in turn sent a copy to the GP & other specialists his patient saw. I have had problems even getting 1 copy of my infrequent blood tests from my GP.
Ahhh…Annie…you live in Victoria.
My sister with a hubby with MS lives in Victoria.
Always a better service.
She lives in central Vic and gets as much help as she needs especially under ALP State govt.
We live in regional NSW. Just to get the appropriate specialist means we visit a doctor 3 hours away once a year.
It has been 25 years of ‘care’ under two State govts and two Fed Govts. I can tell you which one is ‘better’.
Our GP does serve us well…but he cannot control who bulk bills here in regional NSW.
We are dragged down by the co payments and when LNP gain governance then we know we are stuggling.
I once contacted the Ombudsman, but really they don’t have control over the miniscule considerations of the medical profession.
Can you understand that at after over 25 years of dealing with medical matters we try very hard ( especially under Conservatives) to be a very tiny target?
We at one time could get dentistry, physio and dietary help. As soon as the Fed Govt changes we are back to square one.
When questioned the powers that be say that there is a ‘safety net’ for ‘extra payments for specialist payments. Howard organised it so that each year the cut off point goes up. Now we don’t even think if we should follow the graph…too far away from the possibility.
Politics does matter to we on DSP/Carers…but to over 80% they don’t even notice. We live poll by poll with how the media/the common person perceive us.
There have been times when my husband has been so close to suicide I have approached our GP.
Oh and the reason our GP is hard to get into is that we are on the treadmill of the doctor who cares. We tried to get off once and the local ( closer) GP’s said they have ‘shut their books’. This is very common in this area..’no more patients need apply’. If you do get in it is because it is a locum, or a young doctor doing their time in the country area.Don’t expect ongoing interest or long term care. That is not how it works.
I am tired. We are a minority. We don’t matter so we hang onto the GP who knows us all these years ( he is about to retire..what do we do then?) and hope nothing else raises its heads except for 25 years it has been one thing swinging to another.
I don’t take anything anyone says as criticism. I just know “how it is”.
We are caught and we are hanging in for the time we can just be ‘aged pensioners’ except the LNP are trying to change that as well before we get there.
Today is my birthday. I only have 2 1/2 years to go. I hope I make it.
Happy birthday. All the best. ?
Happy Happy Birthday dear Abbie … and many Happy Returns.
I do empathise, even though I don’t know by experience, how it all works up there. .. But I sure take your word for it, and I can understand you wanting to remain a tiny target. … It all sounds gross to me.
I do know however, the incredible amount of energy, constant worry, and fatigue – in being a carer, and on the DSP. My cousin was in much the same situation with her elderly mother – and lived in country Victoria.
I guess you have covered all the bases … but have you looked into the matter of Carers Supplement allowance – available through Centrelink I think. It is a separate thing to the DSP.
I wish you as always, the very best.
Cheers ……
Have a wonderful day Abbie.
On the matter of health it is getting better by the day:
“NSW health minister, Jillian Skinner, revealing to parliament that she was seeking expressions of interest from private operators to run five of the state’s hospitals.”
Our hospitals are being privatised. Is anyone paying attention?
Amy Corderoy https://www.theguardian.com/commentisfree/2016/sep/20/our-hospitals-are-being-privatised-is-anybody-paying-attention
While I am certain of the accuracy of the article, Medicare has a multiple ‘service’ rule applicable to lots of diagnostics, there IS a way around all this that has been around for a few years.
Every Australian has the choice to have a MyHealth Record which I believe should include diagnostic information. Likewise every healthcare professional can register to participate in this service. As a MyHealth record is owned and managed by the patient, you will have control over who has access to this. One specialist can request a diagnostic service, the results are sent to the requesting doctor. Once that doctor has uploaded the diagnostic results to the patients MyHealth Record, then any other doctor may be able to view this if you so permit.
I believe that this will reduce multiple diagnostic events, saving the tax payer, the patient, and the healthcare professional a lot of money and time.
Marty ….
Gosh, I forgot about that. … Some years back, my then doctors, had to supply information to the Government about my health records … with my permission via a signature ( from memory ). … From dates I recall, ( my move from one practice to another as the clinic dispersed ) – it began with Labor. … How far it went after the 2012 election and LNP – I don’t know, as I left that practice some time in 2012 for the above reason.
Since the induction of the LNP mob, I have not seen it from my current doctors introduced to me as an ‘update’ of health information. … At the time, back then – I was rather incensed that my private health concerns could be / should be – given to any government, and I queried it. But my then doctor said it was best to just go along with it – and that all privacy was absolutely protected. … and I did trust her – still would.
And ( again from memory ) there was ample clarification of tests / samples etc. required / requested by the clinic doctors, toward my ongoing health. … I was not however, given a copy of that specific information. That might have been the doctors fault – I dunno. It was an official looking form that I signed, after reading it and checking for accuracy. I was given however, a precis list of my health, medical conditions and medications being used. … Maybe my doctor had registered to do that, and my current doctors have not ?
Having left that practice, I have not followed it up — but will when I again see my current doctors. I have a vague sense that the purpose of the documentation was to indeed prevent un-necessary duplications of services, as you have suggested – and to save a lot of hassle and expense.
However, at the time, I thought it might have been implemented to keep track of not only the doctors ( who were under pressure to NOT request as many tests and interventions – there was a reduction in how many they could request ). That does not seem to hinder my current doctors ordering tests of any description, or referring to specialists, so maybe it has changed ?.
Is this what you are talking about, Marty ?
Thank you so much to all who addressed me directly.
You have NO idea how much it matters. To not feel alone. Thank you.
Appreciated! Really….much appreciated. (Takes a bit of pressure off…Christian Porter et al have no idea!)
Has anyone thought to mention the pathology companies only get paid for 3 tests requested on any one form under the Medicare coning rules. This means if you have more than 3 tests done – the company is doing them for free! Having worked in pathology for many years we often encounter request forms with 10+ tests. I’m not defending the current billing practice of any of these companies but when many are stock exchange listed companies how else can they provide shareholder dividends ( to many of us investors via our superannuation funds) if they don’t make a profit ?