What is a specialist?
Medical specialists, or specialists, are doctors who have completed advanced training in a specific area of medicine. Your general practitioner (GP) may refer you to a specialist if they think there is specific testing needed to diagnose or treat your medical condition.
Some examples of specialists include:
Making your specialist appointment
To make an appointment with a specialist, you need a letter from your GP. This is called a referral. Generally, you will need to show your referral letter either when you make your specialist appointment or when you attend the appointment.
If you haven't seen a GP yet, you can make an appointment with an OSHC Direct Billing GP, or choose to have an online consultation with a GP via the Medibank OSHC app. Your GP will then refer you to a specialist if necessary.
Choosing your specialist
Your GP can help you find a specialist, or they can provide you with a list of specialist names for you to choose from. Your GP may recommend a particular specialist, however, you can always choose your own specialist if you prefer—even if your referral letter is addressed to another specialist.
When choosing a specialist, you may want to consider their:
Your GP should be able to help you find out this information.
Preparing for your specialist appointment
Before your appointment, have a think about your health history, including any lifestyle activities (such as drinking or smoking) that your specialist may need to know about. Your specialist will most likely ask you some questions about your medical history to help give them a fuller understanding of your health needs.
For the appointment itself, you may want to bring:
- your referral letter
- a list of your symptoms, if you have any
- a list of any medications you're currently taking
- any relevant test results
- your Medibank card and health insurance details
- a friend or a relative to help you ask questions and discuss any treatment options
- an interpreter.
You may also find it helpful to practise what you want to say to your specialist, especially if you feel uncomfortable talking about your health condition. Remember, all doctors are trained to talk about sensitive health issues, and they will do their best to make you feel comfortable.
During your appointment
Your specialist may give you a lot of information at once, either about your diagnosis or your treatment. Make sure you understand what your specialist is saying before they move on; ask them to repeat anything you need to hear again. Asking the following questions may help you to guide the conversation at a pace you’re comfortable with.
- What is my diagnosis?
- What treatment do you recommend for my diagnosis?
- How necessary or urgent is this treatment?
- How long will I have to wait for my treatment?
- Is this treatment common for this type of diagnosis?
- Do you have written information or a website I can read that gives me information about my condition and treatment? Is it available in my preferred language?
If you require a procedure or surgery, you may want to ask the following questions as well.
- How long will the procedure take and how long will I be in hospital?
- Will I require local anaesthetic (smaller procedures where you remain awake) or general anaesthetic (longer procedures where you will be asleep)?
- Are there any risks associated with this procedure? If so, what are they?
- Which hospital will the procedure be performed at?
- Will I need any tests before the procedure? If so, what are they?
- Is there anything I should or should not do before the procedure?
- What sort of follow-up care will I need after I leave hospital?
- Will my recovery stop me from going to work or university? If so, for how long?
- Are there any alternative treatments?
- What should I do if my condition gets worse while I'm waiting for the procedure?
- What support services are available to me?
- Will I need a blood transfusion?
After your appointment
If you do need treatment, your specialist will give you some instructions to get started. This may involve making more appointments, getting tests done, or taking medication. Ask your doctor to write down any next steps so that you don’t forget them.
Fees and costs
Getting medical treatment from a specialist often involves several different costs. The table below shows you the kinds of costs you might incur, as well as what your Medibank OSHC can pay towards.
The Medicare Benefits Schedule (MBS) is a list of medical services and corresponding fees set by the Australian Government. Any amount you are charged over and above what you get back from Medibank is called an out-of-pocket cost, or gap cost.
||What your Medibank OSHC will pay towards (for Included services)
||Your out-of-pocket, or gap cost, if applicable
|Your initial GP appointment
||100% of the Medicare Benefits Schedule (MBS) fee
||You must pay any difference between the benefit Medibank pays and the actual fee charged by the doctor/specialist
|Your initial specialist appointment (outpatient)
||85% of the MBS fee
|Any follow-up appointments or tests
For GP services, 100% of the MBS fee
For outpatient specialist or diagnostic services, 85% of the MBS fee
|Prescription medicines, if you need any
Medibank OSHC provides benefits towards the cost of eligible prescription medicines. You will be required to pay a set contribution (called a co-payment) towards the cost of each eligible prescription before we pay any benefits.
The amount Medibank pays towards prescription medicines will depend on which type of Medibank OSHC you hold. Refer to your cover summary for more details.
|Your hospital stay, if you need one
For an Included service in a Members' Choice hospital, Medibank will pay benefits towards overnight and same-day hospital accommodation in a shared or private room, intensive care, theatre fees, labour ward fees and 100% of the MBS fee for inpatient medical services (such as the surgeon or anaesthetist fees). You'll generally get better value if you go to a Members' Choice hospital than to a non-Members' Choice private hospital provided the service you receive is Included under your cover.
If you're treated at a non-Members' Choice private hospital for an Included service, Medibank will generally pay the minimum default benefit set by the government for hospital accommodation in a shared room and 100% of the MBS fee for inpatient medical services. You may incur significant out-of-pocket costs.
Where you're treated as a private agent patient in a public hospital for an Included service, Medibank will pay the cost of overnight and same-day accommodation in a shared or private room, intensive care, theatre fees, labour ward fees and 100% of the MBS fee for inpatient medical services.
Please note, a specialist (such as the surgeon or anaesthetist) may choose to charge above the benefit we pay for Included inpatient medical services (100% of the MBS fee). You must pay any difference between the benefit we pay and the actual fee charged by the specialist, known as an out-of-pocket cost. Refer to your cover summary for further information regarding Included services:
To try and reduce your out-of-pocket costs, follow these next steps. They may make a difference to the cost of your treatment.
- Make your GP appointment with an OSHC Direct Billing GP to help reduce or avoid out-of-pocket costs.
- Contact us to find out if your treatment is included on your OSHC.
- Make sure your specialist works in a Medibank Members' Choice hospital as this may reduce your out-of-pocket costs. If you choose a non-Members' Choice Hospital, it will often cost you much more.
- Ask each specialist involved in your treatment for a full breakdown of costs in writing before the procedure. This is called Informed Financial Consent, and it will give you a clear indication of what costs you can expect to pay.
If you're worried about costs, ask your specialist if you can pay via a payment plan, where smaller payments are made at regular intervals over a longer period.
Read more about out-of-pocket expenses and how to reduce them.
Getting a second opinion
After your initial specialist appointment, if you're feeling unsure about your diagnosis or your treatment plan, you may decide you want a second opinion. This may involve getting another referral from your GP to a different specialist. This is common practice in Australia, and most specialists will encourage you to do so. If you want a second opinion, you should get one as soon as possible so that your condition doesn't change.
You will need to be prepared to pay any additional costs associated with making another GP appointment, as well as the costs of seeing a new specialist.
While we hope you find this information helpful, please note that it is general in nature. It is not health advice, and is not tailored to meet your individual health needs. You should always consult a trusted health professional before making decisions about your health care. While we have prepared the information carefully, we can’t guarantee that it is accurate, complete or up-to-date. And while we may mention goods or services provided by others, we aren’t specifically endorsing them and can’t accept responsibility for them. For these reasons we are unable to accept responsibility for any loss that may be sustained from acting on this information (subject to applicable consumer guarantees).