Author
Bowtie Team
Updated on
2025-07-21
Disclaimer: This article is translated with the assistance of AI.
Is doctor overcharging a serious and widespread issue? What can you do if it happens to you? Join Bowtie as insurance expert Chi Wai breaks it down with practical advice.
In my 14 years in the insurance industry, I’ve often heard about cases where doctors overcharge medical fees. Some clients even encountered suspected overcharging, discovering upon discharge that the surgeon’s fee was 50% higher than the original quote! Late last year, the “insurance companies’ doctor blacklist incident” sparked discussions on LIHKG about doctor overcharging or “doctors without oversight” , with many netizens sharing experiences of themselves or loved ones being overcharged.
What is Doctor Overcharging?
To discuss whether doctor overcharging is common or severe, we first need to define “overcharging.” Medical fees are influenced by many factors, including surgical difficulty, complexity, urgency, the doctor’s reputation, and availability, making it hard to draw a clear line where a fee becomes “overcharging.”
High-end medical insurance in Hong Kong became widely available around 2010, initially only at private room levels. Its near “full coverage” and “lifetime sufficient coverage” design broke from traditional plans with sub-limits and inflation-lagging sums, quickly becoming a market sensation that attracted both clients and doctors.
Some doctors exploited the no sub-limit design, issuing sky-high bills that were multiples of previous fees.
While it’s tough to define overcharging clearly, insurers have introduced “reasonable and customary charges” clauses in recent years to control claims on unlimited high-end medical products and curb fee hikes. However, these standards vary across companies, so they’re not a reliable gauge for overcharging.
But after reviewing enough claim cases, I’m convinced these scenarios count as doctor overcharging:
- The surgery goes exactly as expected, but the actual fee exceeds the quote without a reasonable explanation from the doctor.
- During hospitalization, unfamiliar doctors from various specialties charge thousands in ward round fees, unbeknownst to the patient beforehand.
- The same doctor quotes a higher fee for the same surgery upon learning the patient has high-end medical insurance.
No matter the method, overcharging always leads to higher-than-expected medical costs. So, when assessing if it’s common or severe, one indicator is medical inflation, especially in private and semi-private room claims. Let’s examine if claim figures show skyrocketing medical expenses.
Is Doctor Overcharging Common?
Insurers’ medical claim data isn’t public; only internal staff and frontline agents typically access it. Fortunately, the Hong Kong Federation of Insurers has collected industry medical claim statistics since 2010, from over a dozen local medical underwriters (covering 70-90% of premiums), statistically representing the overall picture.
For our analysis, we’ll use the latest 2021 data and compare it to 2011 figures to see if key metrics like average and median claims have surged over 10 years, shedding light on overcharging prevalence and medical inflation severity.
Since 2011 data only covers group medical policies, not individual ones, we’ll benchmark changes using group data. Over 10 years, average per-case inpatient charges rose from $13,540 to $20,814, a 53.7% increase. Do you think that’s high or low?
Converting the 53.7% cumulative rise to an annualized rate gives 4.39% medical inflation per year, which is 1-2% higher than the composite consumer price index over the past decade , meaning medical inflation is noticeably higher than general inflation .
But judging overcharging from just 4.39% annual inflation and $20,814 average per inpatient case seems inconclusive. So, beyond overall inpatient data, I’ll dive into detailed figures by ward level to uncover more clues about doctor overcharging.
Medical Inflation Higher in Ward Rooms Than Private/Semi-Private
If the emergence of high-end medical insurance is the key factor leading to doctors overcharging, then medical cost inflation in private and semi-private rooms should be higher than in ward rooms. This is because the unlimited sub-item compensation mechanisms are more concentrated in high-end medical insurance plans at the semi-private and private room levels. However, when I carefully analyzed the surgical fee data for hospitalizations across various ward levels, I found an unexpected result: medical inflation in ward rooms far exceeds other levels; in contrast, private rooms have the lowest inflation among the three.
Based on the surgical fee data for hospitalizations across various ward levels mentioned above, the medical inflation chart shows that the room level with the largest increase is the ward room.
To explain this phenomenon, I currently have two thoughts:
- Doctor overcharging is not a widespread phenomenon, at least not occurring extensively in private and semi-private room levels, because in the data for average, median, and high percentiles, none exceed the average increase by much, and some are even below the average;
- The increase in hospitalization costs at the ward room level is far higher than in private and semi-private rooms, with an average cost increase of up to 84.3%, much higher than inflation in other consumer goods and services! The price hikes in ward room medical fees also mean that the threshold for ordinary citizens to stay in private hospitals has become higher than it was 10 years ago!
Although the data does not support that doctor overcharging is a common phenomenon, it does exist in insurance companies’ claim records and public complaints, but its proportion is not enough to significantly affect the claim data. With that in mind, we’ll pull out some cases to share with you and suggest some tips to reduce the risk of doctor overcharging.
Evidence of Medical Overcharging
In 2017, Company A once sent letters to over a hundred doctors regarding “medically necessary” hospitalizations , sparking a round of public debate between the insurance company and the Hong Kong Medical Association. Later, Company A issued a press release , listing some unreasonable charging cases from past claims:
Whether these involve doctor overcharging is up to readers to judge, but if clients proceed with medical procedures after agreeing to the quotes, it can only be said that in a high-end medical insurance system where users pay nothing out-of-pocket, the insurance company might end up as the ultimate loser. This led to the subsequent “reasonable and customary charges” clause to ensure medical fees don’t get “too outrageous.”
Besides the blatantly expensive medical fees with clear pricing, what worries me more is when clients are unknowingly and without warning overcharged tens of thousands by doctors, and once paid, it’s hard to recover. When I produced a video about doctor overcharging earlier, I collected some personal experiences from LIHKG and viewer comments, which seem like clear cases of overcharging, including:
- A LIHKG member needed an endoscopic examination for tinnitus, only to find it was just excessive earwax, which was suctioned and cleaned with instruments, but the charge amounted to tens of thousands;
- During a foot surgery, a LIHKG member was overcharged an extra HK$100,000 by the doctor. Upon inquiry, the reason was that the attending doctor prepared two backup doctors for the surgery. Even though they never appeared in the operation, each still charged HK$50,000 for surgical fees;
- A viewer shared his wife’s experience: the surgery involved removing body tissue and testing it, but the final bill was HK$40,000 more than quoted. Upon questioning, the doctor explained it as waiting fees during the surgery, charging HK$10,000 for every 15 minutes of waiting, so one hour of waiting resulted in an extra HK$40,000, which wasn’t mentioned or included in the initial quote.
Of course, all the above cases are shared by netizens and viewers, and whether they are 100% accurate is hard to verify. At the same time, from the earlier data analysis, overcharging cases are judged to be in the minority and haven’t caused significant increases in medical fees for private and semi-private rooms, so readers don’t need to worry excessively about being overcharged by doctors.
In fact, among the dozens of doctors I’ve known and dealt with, most have sufficient medical ethics, and their charges are quite clear and reasonable, which is why doctors in Hong Kong generally earn respect from the public.
6 Tips to Avoid Overcharging
But if you unfortunately encounter overcharging, what should you do? As a seasoned insurance practitioner, here are my suggestions:
- Before surgery, request a clear quote from the doctor, including surgical fees and other hospital charges.
- After receiving the quote, ask the doctor under what circumstances the actual fees might differ, and the reasons behind it.
- If unsure about the procedure or quote, consider seeking a second opinion and research the average costs for similar procedures.
- Make good use of your insurer’s medical and claims support services, like consulting partnered doctors or institutions, and cashless hospitalization. These can reduce the risk of overcharging.
- During your hospital stay, you may need to settle payments multiple times (like pre-admission deposits, additional deposits, and final balance at discharge). Before each payment, carefully review the bill details for reasonableness, especially high-cost items, and check if they match the quote.
- If you spot overcharging at checkout (like excessive surgical fees, high ward round fees, charges from unknown doctors, or multiple doctors’ fees), immediately ask the doctor or team for explanations. Sometimes, this simple question can save you and your insurer tens of thousands in fees.
Why Partnered Medical Institutions Benefit You
Overcharging might not be as common as you think, but when it happens, it seriously impacts the insurance pool’s health and could leave customers facing higher-than-expected medical bills. On top of that, misuse of medical insurance in various forms (like non-essential cosmetic procedures, unnecessary tests, or non-hospitalization treatments) drives up claims beyond expectations, ultimately fueling medical insurance premium inflation in the long run.
Nowadays, more insurers provide lists of long-term partnered doctors and institutions, offering extra claim benefits (like higher coverage, cashless discharge, and no impact on no-claim bonuses) to encourage their use. Is this trend good or bad for customers?
As long as customers still have plenty of choices, I believe this direction creates fairer and more stable conditions for medical insurance to thrive. By partnering with trusted institutions, insurers gain better control over procedures and fees, reducing misuse and overcharging risks, which helps prevent the insurance pool from bursting. Plus, some insurers and institutions offer fixed-price packages for procedures, letting customers budget confidently without worrying about shortfalls.
Bowtie × Designated Hospitals = Better Experience
Bowtie VHIS Flexi customers can add on the CUHKMC Wellness Package / GHK Wellness Package for just HK$200 per month (uniform rate for all ages and genders), with full reimbursement 1 for over 200 designated all-inclusive surgical / medical procedure packages at the designated hospitals, making it easier to budget your medical expenses. Beyond that, the Wellness Packages also offer these services to protect your health and streamline claims:
- Annual basic health checkup and optional health check items / services 2
- No need to apply for cashless hospitalization service 3
- 1 Full reimbursement is only applicable to the fees of specified medical packages at designated hospitals, and is subject to the annual benefit limit of the insured person’s VHIS Flexi Plan policy. The insured person must directly pay the designated hospital for all expenses not pre-approved by Bowtie before discharge.
- 2 Annual basic health check and optional health services are only applicable to certain age groups. For details, please refer to the respective wellness package websites.
- 3 For any related surgery/medical procedure of the specified medical package planned to be performed at the designated hospital, the designated hospital will submit a pre-authorization application to Bowtie on behalf of such medical package. The cashless discharge service can only be enjoyed after approval by Bowtie. For details of the terms and conditions of the cashless discharge service, please refer to the relevant service application form.
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