He said charging tens of thousands of dollars in out-of-pocket costs to individual patients was rare and “an embarrassment” that would make the front page of the newspaper, but the more common practice of splitting bills was far more common and needed to be stamped out. Bill splitting between specialists involved a surgeon and an anaesthetist, for instance, who share a “close relationship” using extended Medicare safety net work-arounds to find extra item numbers to charge patients up to 45 times the Medicare Benefits Schedule anaesthetics fees and up to 16 times the MBS surgical fees, Dr Horsburgh explained. “But it most cases it is simply a booking fee,” he said. This other form of bill splitting occurs when a doctor sends separate bills to a patient and their private health insurer. The insurer will pay the higher no-gap or known gap rate for a procedure, under the impression that this is all the patient has paid, when in fact the patient has been given a separate, potentially exorbitant, bill from their specialist. “Doctors will tell you that they do this because if they have a ‘known’ gap situation, the patient gets a smaller rebate from their private health insurance than if it’s a no gap situation," Dr Horsburgh said.

“But this is disingenuous, it is cowardly and they should be prepared to stand up and say the fee is 'X' and if they don’t like it they can go somewhere else,” Dr Horsburgh said. “Be honest with patients because it is doing our collective reputation no good at all.” Dr Horsburgh said an upcoming ABC Four Corners program investigating doctors' out-of-pocket fees “will cause a considerable amount of pain on Monday night”. “It reflects a side of our practice which … needs to be questioned,” he said. Outgoing AMA president Dr Michael Gannon said with the vast majority of the medical profession charged appropriate fees.

He strongly supported the motion concerning the “often immoral, unlawful and egregious behaviour”, and cautioned against conflating essential care planning management fees with egregious booking fees. Loading Roughly 89 per cent of privately insured medical services are charged at no-gap by Australian doctors, according to Australian prudential Regulation Authority figures. Another 6 per cent are charged under known gap arrangements, leaving roughly five per cent that exceed acceptable levels. But these statistics risk becoming meaningless as the practice of splitting bills and ‘booking fees’ increases, delegates were told.

Anaesthetist Associate Professor Ross Kerridge said doctors who charged exorbitant fees needed to be denounced by their peers. “We need to come to terms with the fact that some doctors are engaging in behaviour that does no good for anyone,” Professor Kerridge said. He said in some case doctors were billing patients over $100,000. “We need to start calling people out and we know who … at least one of them is,” he said without elaborating further.

The high cost of medical assistance amounted to "emotional blackmail" in some instances, Ross Kerridge says. Credit:Naomi Colley Professor Kerridge pointed to the crowd-funding site GoFundMe, where dozens of pages have been set up by friends and relatives of severely ill people trying to raise dizzying amounts to pay surgical fees. “They are emotionally blackmailed,” Dr Kerridge said.“It’s outrageous.” GP and former AMA president Dr Steve Hambleton said some patients did not have the luxury of shopping around to test prices. He said GPs were currently least likely to know what costs specialist would charge their patients.

“The broader argument is about transparency of fees and allowing GPs to advocate for patients and help select appropriate specialists." A total of 96 per cent of delegates voted in favour for the AMA considering the reputational impact bill splitting and booking fees had on medical profession, almost 90 per cent supported a public campaign to denouncing the practices. Delegates also wanted fees indexed against itemised schedules such as the MBS or AMA fees lists so that patients knew higher fees amounted to over-charging. The resolutions are advisory only and will be submitted to the AMA’s Federal Council for consideration and implementation.