Treatment in the private health system | ISSUE OF CONCERN

Around half of Australians have private health insurance. Many people choose to have it because they hope it will help if they have a major illness like cancer. However, the results of BCNA’s recent The financial impact of breast cancer report show that holding private health insurance may mean you pay high out-of-pocket costs for some tests and treatments.

Our survey of 1,919 women across Australia found that women with private health insurance can pay almost twice as much in out-of-pocket costs for their breast cancer treatment as women without private health insurance – $7,000 compared with $3,600. These amounts are for out-of-pocket costs for the first five years only and do not take into account lost wages and superannuation.

Some women with private health insurance pay much more than this. A quarter of privately insured women reported paying more than $20,000 in out-of-pocket costs.

Direct medical expenses (tests and treatments) are the biggest contributor to the higher costs. Women with private health insurance paid approximately 10 times as much as women without private health insurance for their direct medical costs – $3,723 compared with $355.

This shows that the greater financial burden for women with private health insurance does not come from choosing more expensive items and services, for instance a $2,000 wig as opposed to a $400 wig. Instead, it comes from higher out-of-pocket costs for ‘gap’ payments for surgery, chemotherapy and radiotherapy treatment, breast MRI and other scans, and specialist consultations.

BCNA is concerned that many women say they do not receive up-front information about the out-of-pocket cost of their treatments.

Before we went to see the plastic surgeon I would have liked to have known how much it was going to cost. It’d be nice to know the average price range of this operation with or without private health cover. – Susan

Women with private health insurance may not know that they can choose to have their treatment in the public health system, or to have some of their treatment in the private health system and some in the public health system. Women may not be advised they can ‘shop around’ to compare prices.

We know that the financial cost of breast cancer is an important issue. We have developed some tips for reducing the financial impact of breast cancer if you have private health insurance.

  • You do not have to have your treatment in the private health system. You can choose to go public if you prefer, or to be a private patient in a public hospital.
  • You can also move between the private and public health systems, for example you may have surgery and chemotherapy in the private health system as these are covered by private health insurance, and radiotherapy (not covered by private health insurance) in the public health system. Your doctor may assume that if you have private health insurance you will want to be treated in the private system, but you can ask your doctor for all of your options.
  • Get a second opinion about the costs of your treatment. You can ‘shop around’ and ask questions about your doctors’ fees in the private system. You should ask for a fully itemised quote before you make your decision. Remember that breast cancer treatment is often not urgent – you will most likely have time to consider your options.
  • Call your private health insurance fund before booking any treatment. Your private health insurance fund will have a list of specialists with whom it has a no-gap or known-gap agreement. Going to these specialists may reduce the ‘gap’ payment you have to pay. You can call your health insurer to find out more about no-gap or known-gap doctors.
  • Review what is and what isn’t covered by your private health insurance policy. The level of cover you hold with your private health insurance fund may mean you are not covered for some treatments, even if your level of cover is described with words like ‘top’ or ‘comprehensive’. You can call your health insurance fund to find out more about your level of cover.

Read more tips for reducing the financial burden of breast cancer on our website.

It is important for women to realise that even though they have private health insurance they may still be potentially significantly out-of-pocket. The best way to alleviate financial stress during this time is to ask questions of the doctors before treatment or when trying to make decisions about treatment options. – Jill

Jill drinking tea while sitting on her couch at home

Jill

Issue 81
Summer 2017