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Everyone in Australia with a Medicare number can get free treatment in a public hospital. In a public hospital, you may have access to more services, especially if you have a complex health condition, need emergency treatment or if you live in a rural area.
Private Patients
If you have private health insurance, you can choose to be treated as a public patient in a public hospital, or as a private patient in a private or public hospital.
may have a shorter wait time for planned surgery and may be more likely to have a private room. Private hospitals are those owned by the private sector but are still licensed by the government. If you have private health insurance, you can choose to be a private patient in either a public or private hospital. A combination of Medicare, private health insurance and out-of-pocket costs will cover your stay.
Can I be a private patient even if I don't have private health insurance?
You can choose to be a private patient in a private hospital even if you do not have private health insurance. You will have to pay for most of the fees yourself, but Medicare will pay for 75% of the schedule fee. You are responsible for any excess costs.
Private Patient in a Public Hospital
In some cases, individuals can opt to engage a specific surgeon for their endometriosis treatment, even if they plan to undergo surgery in the public healthcare system. While this can incur private consultation fees, accessing surgery through the public system can significantly reduce the financial burden associated with hospitalisation and surgical costs. It is advised to explore this option while considering the expertise of the surgeon and the waiting times within the public system. You can talk to your surgeon to explore this option.
Gap Payment
A gap payment, also known as an out-of-pocket cost, is the difference between what a medical provider charges and what Medicare and your private health insurance pay. This may occur because your doctor's fee is higher than the Medicare benefit, your hospital insurance has exclusions, benefit restrictions, or an excess, or because you incurred charges for items not covered by your health insurance, like phone calls or newspapers.
Surgery Cost Information
Cost of Laparoscopy (Public and Private)
Cost of Endometriosis Resection Laparotomy (Public and Private)
Health Insurance Considerations
Hospital Cover
Endometriosis care can involve different specialists, surgical procedures, medications and allied health care (e.g. physiotherapists, dietitians, psychology). When selecting hospital cover it is important to prioritise plans that offer comprehensive gynaecological coverage, particularly for surgery. When considering surgery, it is always a good idea to get a detailed quote from your surgeon, anaesthetist, any assisting surgeons/specialists, hospital fees and check the level of cover (and any potential out-of-pocket costs) with your health insurer.
It is important to note that the waiting period for pre-existing ailments can be 12 months from the date of joining or upgrading your cover.
Extras Cover
This can also be purchased which can provide benefits for allied health care (e.g. physiotherapist, dietitian, psychologist) and may also include benefits for pharmaceuticals prescribed for pain management and hormonal therapies, which can significantly reduce out-of-pocket expenses. When choosing an extras policy, it is important to consider which health practitioners you see regularly and whether you need pharmaceutical coverage. Then check what is included in each policy and the amount that is covered by each policy. When purchasing a new policy or transferring to another company you may have to serve a waiting period before you can claim some medical costs.
Additional resources
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