Specialist Doctors

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What are specialist doctors?

Which parts of the body do different specialists treat?

How much does it cost to see a specialist?

Does Medicare cover seeing a specialist?

Does my health insurance cover seeing a specialist?

How do I get an appointment with a specialist?

How can I find and compare health insurance?

Long story short

A specialist doctor is a trained expert with a particular medical focus

There are lots of types of specialists, from heart specialists to those who focus on pregnancy care.

There are no standardised fees for specialists, but you can always ask for a quote

You might need to be prepared for some out-of-pocket costs.

Medicare and your health insurance might help cover some of the fees

This can be affected by whether you’re in hospital, being treated as a public or private patient, and other factors.

What are specialist doctors?

Specialists are different from your regular general practitioner (GP). Where your GP has a broad knowledge of medicine to holistically look after your health, a specialist is focused on a specific part of medicine. This could be a part of the body, like your lungs, or even a method of diagnosis or treatment, like radiology and surgery.  

Your GP might refer you to a specialist for a diagnosis and, hopefully, a treatment too. 

There are lots of types of specialists, and you can find them in clinics and hospitals. They can also become further specialised, like a gynaecologist becoming a gynaecological oncologist. This can also include becoming a surgeon, so they can operate on you as part of their overall treatment plan.  

The interactive diagram below shows you which specialists deal with which parts of your body or health. 

Which parts of the body do different specialists treat?

How much does it cost to see a specialist?

As with lots of other services, from plumbers to beauticians, specialists are free to set their own fees. Of course, they aren’t just picking a number out of thin air. They can use the Medicare Benefits Schedule (MBS)¹For more information, see Department of Health and Aged Care – MBS Online and the Australian Medical Association’s Fees List²For more information, see Australian Medical Association – AMA Fees List for guidance. 

When it comes to deciding their fee, specialists are likely to take into account things like: 

• their own skills, expertise, and experience
• how complex a patient’s condition is – the more complex it is, the more time and resources are likely to be required
• the financial reality of running a practice, like needing to pay staff and so on. 

If you were to do a survey of specialist fees, you’d likely find they’re all different just because of these factors alone. But there’s one more thing to consider: if your specialist bulk-bills. 

Bulk-billing is when a medical practitioner only charges the MBS fee. They bill Medicare directly and get the rebate to cover their services. If that’s the case for your specialist, you could leave your appointment with only having gotten your Medicare card out.  

Unfortunately, it can be tricky to find a specialist who bulk-bills. In 2019–20, the national specialist bulk-billing rate was 34.5%, but by 2023–24 it had dropped to 28.7%.³Includes both hospital and out-of-hospital specialist services; Department of Health and Aged Care – Medicare annual statistics – State and territory (2009–10 to 2023-24) So, while you can certainly try your best to get that bulk-billed appointment, you may need to bring your wallet along when you see a specialist. 

This table shows what the typical appointment fees and out-of-pocket costs were in 2022–23 for some common specialists if the patient wasn’t bulk-billed, along with what percentage of patients had out-of-pocket costs. For specific information about what a specialist may charge you, you can always ask them for an estimate. 

Note: These are the amounts patients typically paid for these services, rounded to the nearest dollar. They do not include aftercare costs, pharmaceutical costs, or costs for other incidentals. These fees may vary depending on your situation. Not all patients had out-of-pocket costs; those who didn’t aren’t included in these figures. Data retrieved January 2025. 

Does Medicare cover seeing a specialist?

If your specialist bulk-bills or you’re a public patient in a public hospital, then Medicare will cover the entirety of the specialist’s fee. That’s assuming your GP referred you. 

Of course, not all specialists bulk-bill. But that doesn’t mean it’s entirely up to you to pay for your appointment. As long as you’ve got that referral letter, Medicare will pay 85% of the MBS fee for your out-of-hospital appointment (not 85% of the bill, unfortunately). You’ll just need to pay the gap payment – what’s leftover on the bill. This tends to be the case if your specialist is at a private clinic at a public hospital. 

If you’re a private patient at a public or private hospital, Medicare may cover 75% of the MBS fee for your specialist’s services. You might have out-of-pocket costs for other bills from your hospital stay, though. 

Does my health insurance cover seeing a specialist?

Helpful tip:

While your health insurance might not cover an out-patient specialist appointment, it could cover appointments Medicare doesn’t typically cover. Depending on your extras policy, your insurer may cover some of the costs of seeing the dentist, along with allied health professionals like physiotherapists, optometrists, dietitians, and psychologists. 

Andres Gutierrez

General Manager – Health

How do I get an appointment with a specialist?

To get an appointment with a specialist, first you’ll need to make an appointment with your GP. It’s your GP who can write you that important referral so you can claim some money back with Medicare.  

At this appointment, your GP can give you recommendations for specialists to see. Of course, you can come prepared with your own list of names. Friends and family may speak highly of certain specialists, or you might want to do your own research.  

You don’t need to have made your decision by the end of your GP appointment, though. Your GP can always leave that part of your referral blank, so you can decide on the specialist you’d like to see at a later date. 

After all, picking a specialist isn’t as simple as choosing an ice cream flavour on a hot summer’s day (although that can be tricky, too!). You might want to consider: 

• the specialist’s qualifications and experience, like whether they regularly treat your condition or concern
• where they’re located, including how you’ll get there
• their availability, as some specialists may have long waiting times
• whether they bulk-bill or have an agreement with your insurer
• what their fees are and what options you have to pay them, including payment plans and any discounts. 

If after all that deep thinking, you just don’t click with your specialist, or you’d like to get a second opinion, that’s okay. You can always head back to your GP to get another referral.  

Aim to get this referral – and your appointment with a new specialist – sooner rather than later. Otherwise, your condition may progress, changing the diagnosis or treatment advice as a result. This can then make it hard to compare the specialists’ opinions. 

How can I find and compare health insurance?

Health insurance can come in handy if you ever need a specialist’s services in a private hospital. With it, you could have some of your costs covered while enjoying the benefits of being a private patient. 

If your current health insurance doesn’t feel all that special, or you don’t have a policy at the moment, iSelect is here to help. With our online comparison tool, you can compare a range of policies in minutes. Alternatively, you can call 1800 784 772 and speak with one of our health comparison experts.