Unhappy patients and the reimbursement or waiver of fees

MIGA often receives calls from members asking for assistance in relation to a patient request for:
  • Waiver of gap fees
  • Reimbursement of fees already paid
  • Payment of out of pocket expenses relating to treatment, or
  • Consequential treatment to be provided without cost. 
Requests usually arise where the patient believes that their medical care has been below the acceptable standard. Sometimes this may be true, however on other occasions the outcome might be within the expected range and the request is an expression of frustration or misunderstanding by the patient. We are always mindful that patients often have unrealistic expectations of the medical profession and treatment outcomes.

Issues you may wish to consider when deciding about reimbursement include, but are not limited to the following:
  • The likely outcome if the patient’s request is denied
  • Nature of the request i.e. whether it is a request for waiver of fees, reimbursement of fees, request for costs of future treatment etc.
  • The nature of the problem from the patient’s perspective
  • Consideration on the treatment provided and outcomes
  • Your exposure to further criticism by the patient including a possible complaint to State based health complaints body, or publicly via social media
  • Your wishes
  • Value of request. 
It is very important to understand that meeting these requests does not constitute an admission of liability.
Where the patient is unhappy, there is no substitute for good ongoing communication with the doctor.
Each case should be considered on an individual basis. Fees should routinely not be waived or expenses reimbursed on each occasion where there is a disgruntled patient.  Whether or not the outcome has been ideal, doctors are entitled to charge a fee for medical services provided.
Consideration of all issues is important, including:
  • the quality of the care provided,
  • the doctor believes  it is fair, reasonable and appropriate.
Whatever the decision it should be communicated to the patient appropriately by letter or phone call explaining the basis for the decision. This should help the patient feel reassured that their complaint or concern has at least been considered and addressed even if the request is not met.

In our experience, reimbursement does not necessarily mean the end of the matter and we can assist in best achieving closure.
Requests to MIGA for reimbursement of out of pocket expenses and payments are made on a case by case basis and will only be made where in our view, following investigation, there is a sound basis to do so. On occasions we may require the patient to sign a release and discharge deed prior to payment. 

Insurance policies are issued by Medical Insurance Australia Pty Ltd (AFSL 255906).  MIGA has not taken into account your personal objectives or situation.  Before you make any decisions about our policies, please review the relevant Product Disclosure Statement (which can be found here) and consider your own needs.
Information on this site does not constitute legal or professional advice. If you have questions, or need advice please contact us for assistance.