What cheeses me off

[Katie]

Went through this whole referral shenanigans years ago with The Teen and their ophthalmologist. Started seeing him when the Teen was 3-4 months old, and kept seeing him, at varying levels of frequency, until the Teen was 11 or so. Including surgery on the Teen's eyes at 13mths.

My GP then tried to write a perpetual/indefinite referral the first few times. Specialist's receptionist kept telling me we needed a new referral each year. Eventually, my GP's receptionist commented that at the start of each new referral, the specialist gets more back from Medicare than they do for the subsequent visits during the referral year. No idea if this is true.

It is bloody annoying when it's an ongoing/permanent issue, and you need to follow up annually. I now put reminders in my calendar for a week or two before the specialist appts that we need a new referral. It's been the same seeing the Teen's developmental paediatrician for the past 7 or 8 years. GP has no involvement in managing those issues, and can't. With the Teen's age, I think we'll be needing to find a psychiatrist soon, as the Teen will age out of being able to be dealt with by the paed.

What cheeses me off with specialists and charges - when the Teen was diagnosed autistic two years ago, the paed said the fees for that appt required a certain code for the system (Medicare?) to know she was autistic/formalise the diagnosis.
BUT this code only involves a Medicare rebate if the child is under 14. The Teen was 14 1/2. $250-300 appointment with not even a basic $60 Medicare rebate. Arrgghh.

 

[MARTINE]

Went through this whole referral shenanigans years ago with The Teen and their ophthalmologist. Started seeing him when the Teen was 3-4 months old, and kept seeing him, at varying levels of frequency, until the Teen was 11 or so. Including surgery on the Teen's eyes at 13mths.

My GP then tried to write a perpetual/indefinite referral the first few times. Specialist's receptionist kept telling me we needed a new referral each year. Eventually, my GP's receptionist commented that at the start of each new referral, the specialist gets more back from Medicare than they do for the subsequent visits during the referral year. No idea if this is true.

It is bloody annoying when it's an ongoing/permanent issue, and you need to follow up annually. I now put reminders in my calendar for a week or two before the specialist appts that we need a new referral. It's been the same seeing the Teen's developmental paediatrician for the past 7 or 8 years. GP has no involvement in managing those issues, and can't. With the Teen's age, I think we'll be needing to find a psychiatrist soon, as the Teen will age out of being able to be dealt with by the paed.

What cheeses me off with specialists and charges - when the Teen was diagnosed autistic two years ago, the paed said the fees for that appt required a certain code for the system (Medicare?) to know she was autistic/formalise the diagnosis.
BUT this code only involves a Medicare rebate if the child is under 14. The Teen was 14 1/2. $250-300 appointment with not even a basic $60 Medicare rebate. Arrgghh.

That is correct
Perpetual referral = followup visit payment
New = first consult

When members of my family were GP’s in the 70’s std consult was around $8 and $15 for long. Now its what $30 something for std?

Edited to add:
std - standard (not the medical acronym)

 

[RooFlyer]

Most GPs can quickly write a back dated one and send off

I had a similar case (thought I'd told it, but couldn't find it above). Saw a specialist and what used to be a perpetual referral from my GP lapsed when the GP retired. Again, only found out on specialist check-out, so prospectively no rebate.

Asked my new GP a few days later when I saw him ... very tentatively (as I suspected the answer)... if he could give me a referral dated prior to my specialist appointment. No way! Fraud! (Fortunately he saw the humorous side of it).

He's right, isn't he?

 

[Quickstatus]

He's right, isn't he?

Backdating is definitely illegal under the health insurance act.
Having said that there is the very grey area where a genuine mistake was made. Let's say referral valid for x months and you saw the specialist x months + 2 days later due to some unrelated issue. In such areas, where there is a clear intention of referral and the referral was outdated only because of a delay in making an appointment/ secretary stuffup, Or you went to the emergency dept and they referred you to a specialist. But the referral was written by the junior Dr who may or may have referral ability under Medicare. Obviously the junior Dr referred on behalf of the senior Dr in emergency, but when the claim goes through Medicare says invalid. Medicare will support genuine mistakes such as these. But Grey area and you would not want a repeat.

That's medical secretaries are often worth their weight or more in gold. They sort out all these bureaucratic "specials".

The other problem with the resubmission of a Medicare claim like this will likely need a covering letter explaining the circumstances and why the rebate should be paid. It will be like writing to QF for a refund / IROPS expense claim - painful...

 

[TheRealTMA]

I had a similar case (thought I'd told it, but couldn't find it above). Saw a specialist and what used to be a perpetual referral from my GP lapsed when the GP retired. Again, only found out on specialist check-out, so prospectively no rebate.

Asked my new GP a few days later when I saw him ... very tentatively (as I suspected the answer)... if he could give me a referral dated prior to my specialist appointment. No way! Fraud! (Fortunately he saw the humorous side of it).

He's right, isn't he?

Yes. They are getting cautious over back dated referrals these days.

 

[Seat0B]

Most GPs can quickly write a back dated one and send off

Yes, but my GP said that would be Medicare fraud and I kind of see his point.

And really the specialist secretary stuffed up there. Usually they are like lounge dragons - you can't get in without a valid one and everytime you make an appointment, they check your "FF status".

Yes totally agree and I did suggest they should help out financially. They just said no - it's the patient's responsibility - which brings me back to being cheesed off - how is a patient supposed to know the ins and outs of Medicate rules??? Anyway, to quote from a health insurance ad, "I feel better now" for having vented

 

[Quickstatus]

how is a patient supposed to know the ins and outs of Medicate rules?

You can't, even providers have issues with medicare rules.
Drs have been accused of medicare overservicing by some quarters. But the reality is that most of us find it easier to claim a smaller number because claiming a larger (more valuable) item number is problematic even if completely valid. This is because medicare looks at your claims history and compare with your peers. If you are an outlier you are often sent a please explain letter with the associated paperwork and claims substantiation requests - so the risk of an audit, means that Drs often claim less, or not at all.

 

[Cruiser Elite]

…………… is incessant posting of GP / Specialist referral content here instead of the dedignated thread

 

[Seat0B]

…………… is incessant posting of GP / Specialist referral content here instead of the dedignated thread

Harsh. A number of people share my cheesed offedness at this issue which came as a complete, unwelcome, expensive surprise to me.

 

[JohnK]

Thanks @MARTINE I will ask again. I have a newish GP. My old one told me a couple of years back that it was not possible to do that any more. That might be false and might be part of the reason I now have a new GP.

I visit a few outpatients clinics and with each one now I have an indefinite referral.

I'm not sure if they've stopped doing them for new referrals but it used to be a nightmare trying to keep up and scheduling appointments with GP everytime I needed a new referral.

 

[MARTINE]

Harsh. A number of people share my cheesed offedness at this issue which came as a complete, unwelcome, expensive surprise to me.

It is a cheesed off thread.. sometimes it helps to feel heard and vent and there is no offense to anyone

 

[serfty]

That is correct
Perpetual referral = followup visit payment
New = first consult

When members of my family were GP’s in the 70’s std consult was around $8 and $15 for long. Now its what $30 something for std?

Edited to add:
std - standard (not the medical acronym)

Currently $39.75 for standard consultation, $76.95 for extended. $51.80 for Weekend/Public Holiday.

 

[Lynda2475]

Inconsiderate cough who book a day tour then fail to be at the designated pick-up point on time inconveniencing those who bothered to wake up on time.

Then guide who waits 20 mins instead of leaving per schedule (after 5mins) only to eventually call the laggards whi decide its too early and not bother.

 

[p--and--t]

Inconsiderate cough who book a day tour then fail to be at the designated pick-up point on time inconveniencing those who bothered to wake up on time.

Then guide who waits 20 mins instead of leaving per schedule (after 5mins) only to eventually call the laggards whi decide its too early and not bother.

I loved the guide in Japan. Took no prisoners. Be on the bus at 0830 or we leave without you. The driver pulled out into traffic at 0831.

 

[Pushka]

Inconsiderate cough who book a day tour then fail to be at the designated pick-up point on time inconveniencing those who bothered to wake up on time.

Then guide who waits 20 mins instead of leaving per schedule (after 5mins) only to eventually call the laggards whi decide its too early and not bother.

We had one guide waste 30 minutes to return to a ship waiting for these idiots. Ran us so late he ended up having to get special permission to bring us straight to the ship on the dock. Stressed and Furious.

 

[blackcat20]

My Contiki tour guides were great when I was younger. If you weren't at the bus for an activity you had to make your own way there, and they stuck to that.

 

[Yearlylonghaul]

Inconsiderate cough who book a day tour then fail to be at the designated pick-up point on time inconveniencing those who bothered to wake up on time.

I agree. It seems to me that often, the ones that run late seem to have a chronic lateness condition. They couldn't care less about their fellow workers or travellers.
Even more irritating is when you chip them about it, their response can be for us to "chill".

 

[VPS]

My Contiki tour guides were great when I was younger. If you weren't at the bus for an activity you had to make your own way there, and they stuck to that.

Same with my Contiki tour even if we were going to another city. A couple of times people were left behind and had to get a train

 

[JohnK]

Same with my Contiki tour even if we were going to another city. A couple of times people were left behind and had to get a train

I remember one couple missed one of the departures from Florence to Paris and they had to make their own way there.

I used to wake up late all the time in those days and I was terrified I was going to be left behind. Woke up each time early without fail and even made it to boring continental breakfast.

I liked that our Contiki tour in 1994 was casual and not military strict for both morning departures from hotel and pick-ups after lunch. They did wait 5-10 minutes if anyone was running late.

 

[Hvr]

I've only ever had one experience where a late arrival was accepted by the driver and fellow passengers.

We were due to meet in the city Square in Bath for a tour of the Cotswolds. I'd done a tour the previous day with the same company to walk amongst the stones at Stonehenge.

The meeting time was 0730 hours and several of us had arrived early after being on the previous tour. The driver/guide was also early and he received a phone call advising that two guests were delayed. The story was they'd got stuck in the hotel toilet and the fire brigade attended to help free them. The driver was a retired firefighter and rang his former colleagues to check the veracity of the story. It was true. The two women were about 20 minutes late and upon arrival laughed with us as we sung the song about two old ladies locked in the lavatory.

Two other passengers arrived with their luggage despite the conditions of the tour being no large bags. However, they also had a very good reason to be granted an exception to the rule.

The previous day's tour finished (on time) at about 2230 hours. As they walked to their nearby hotel they were stopped by police. There was an unexploded WW2 bomb near their hotel. After showing identification they were allowed a couple of minutes to get their luggage and ended up at a hotel several miles away in another suburb.

The driver correctly declared that exigent circumstances meant we would carry the extra baggage and we all had a great day visiting the Cotswolds.