That is how Moree mother-of-three, Melissa Mackay, felt when she found out a number of her friends had recently been charged more than $200 for an ultrasound, when the service was previously bulk-billed.

Although this cost is partially rebated by Medicare, Ms Mackay said it’s only a minimal amount.

“I’ve got a few friends starting off in their pregnancies,” she said.

“One has had six scans and is only at nine weeks. For someone like her, it’s costing her a mint. It’s going to be a million-dollar baby by the time it’s born.”

Ms Mackay has recently given birth to her third child and said she was lucky to have missed out on being charged for ultrasounds herself, however she said she feels for those in the community who will need multiple scans in the future.

“I just want to make the community aware,” she said.

“The main question I have is why so much? Why can’t it be a reasonable amount?”

According to Aplenglow Australia – the company which owns Moree Diagnostic Imaging – the decision to introduce a fee structure in Moree was necessary to provide and maintain a modern standard of care.

Alpenglow currently has 17 sites across rural and remote NSW and Queensland, with all sites now operating with a mix of private and bulk billing.

Moree was the last of Alpenglow’s practices to introduce private billing.

Alpenglow Australia chief operating officer Nynne Pedersen said since Alpenglow acquired the Moree ultrasound/CT/mammo department in 2015, they have been working with Hunter New England Health and Moree Hospital to improve the services for Moree patients.

“It was our belief that such improvement was overdue,” Ms Pedersen said.

In December 2017, a major redevelopment and refurbishment of the Moree department saw the replacement of its ageing CT scanner with a state-of-the-art 128 slice Ultra-Low Dose Siemens CT scanner, which enables improved diagnostic imaging and safer CT interventions.

A digital mammography unit was also installed.

“It also gave our staff and patients some much-needed space as the new footprint of the department is twice the size as the old space,” Ms Pedersen said.

“Alpenglow and Moree Hospital worked closely together on the refurbishment and ensured a minimal down time of the services to Moree community. This was successful and a full rebuild of the practice has now been completed.”

Ms Pedersen said Alpenglow is also striving to continuously improve the quality of services it offers Moree patients with reduced turnaround times for reports and a focus on better IT solutions and delivery of reports.

They are also passionate about attracting and retaining dedicated, qualified staff which requires significant investment.

However, with no indexation of the Medicare Benefits Schedule for diagnostic imaging items for nearly 20 years, Ms Pedersen said a mix of billing is necessary.

“We aim to provide a standard of care equal to and beyond that expected in a non-regional setting,” she said.

“With our hope to deliver quality services to rural Australians by providing state-of-the-art services and equipment with real time reporting to, we believe this mix of billing is paramount to sustaining our services.”

While patients having an ultrasound or mammogram will now be charged an out of pocket fee, which will be partially rebated by Medicare, those requiring a CT scan will continue to be bulk billed.

Pensioners will also continue to be bulk billed for all services.

Since introducing their fee restructure on March 5 this year, Moree Diagnostic Imaging has been conscious of minimising the impact on its patients.

As a result, they have visible signage about the new billing policy around the site and patients can get a quote of all upfront fees at the time of booking.

“We hope the Moree community will be understanding and we thank you for your continued support,” Ms Pedersen said.

Ms Pedersen also thanked the dedicated staff at Moree Diagnostic Imaging.

“Michael Proudfoot has been a long-term dedicated sonographer/radiographer and practice manager and has always had the best interest of the patients at heart,” she said.

“Tricia and Simone have handled the transitions from different private providers with excellence and are always warm and professional to the Moree patients.

“Our new radiographer Paige is young and enthusiastic. She comes highly trained from a background in busy high-end practices in metropolitan Queensland. She has settled with her future husband in Moree and will become a cornerstone of the department in the future.”

Although she understands that Moree is lucky to have been bulk-billed up until now – as diagnostic imaging services in other towns have been charging patients for years - Ms Mackay worries that people who can’t afford it will either not have scans, or travel away for them.

“I think it could deter people – they’ll just travel away which will take money to different towns; I know Goondiwindi doesn’t charge,” she said.

“I’ve had people telling me they won’t have an ultrasound for their whole pregnancy.”

Medicare is our public health insurance system, which funds a range of services such GP visits, blood tests, imaging and consultations with other medical specialists.

The Medicare Benefits Schedule (MBS) lists the services the Australian Government will provide a Medicare rebate for.

Medicare rebates do not cover the full cost of medical services and are typically paid as a percentage of the Medicare schedule fee.

GPs or providers who bulk bill agree to charge the Medicare schedule fee and are directly reimbursed by government.

Those who don't bulk bill are free to set their own prices for services. Patients pay for their treatment and receive a rebate from Medicare.

There is often a gap between what patients pay for services and the amount that Medicare reimburses ($37 for a GP consultation, for example). This gap is known as an out-of-pocket expense, as the patient is required to make up the difference out of his or her own pocket.

Under an indexing process, the Medicare Benefits Schedule fees are raised according to the Department of Finance's Wage Cost Index, a combination of indices relating to wage levels and the Consumer Price Index.

Organisations such as the Australian Medical Association (AMA) have long argued this process is insufficient, and Medicare schedule fees have not kept up with “real” increases in costs faced by medical practitioners and providers.

The rebate freeze compounds this financial challenge by continuing to keep prices at what the AMA and others argue are “unsustainable levels”.