Health insurance for gastroscopy
Gastroscopy is covered by Medicare and by private insurance. Find out what's best for you.
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Undergoing a gastroscopy is common among adults as we get older, and it can help diagnose as well as stop more serious conditions from developing.
It is usually covered by basic health insurance, so it's not difficult to find. This guide helps you look at what gastroscopy is, how it can help you and how both Medicare and private health insurance compare.
What is a gastroscopy?
A gastroscopy is a procedure used to examine your oesophagus, stomach and the first part of your small intestine, also known as the duodenum. For the procedure, you would probably need to take a sedative. Your doctor would then put a thin tube with a camera, called a gastroscope, into your stomach through your mouth. The doctor would gently feed the tube down your oesophagus to your stomach and duodenum.
Your doctor often uses small biopsy forceps that can pass through the gastroscope to take tissue samples for diagnosis.
What is a gastroscopy looking for?
A gastroscopy is used to look for abnormalities in your oesophagus, stomach and duodenum. Common reasons for a gastroscopy include symptoms and issues like indigestion, nausea or difficulty swallowing. The following are some other reasons your doctor might prescribe the procedure:
- Abdominal or chest pain
- Nausea and vomiting
- Abdominal bloating
- Stomach ulcers
If your doctor recommends you get a gastroscopy, it's often because they are looking for the following:
- The narrowing of the oesophagus, known as oesophageal stricture
- Stomach polyps
- Hiatal hernia
- Coeliac disease
- Bleeding in your stomach
- Lactose intolerance
- Inflammation of the stomach (gastritis)
- Stomach cancer or oesophagus cancer
How long does a gastroscopy take?
The procedure takes around 15 minutes and is considered very safe. Preparation takes a little longer as your stomach needs to be empty. You'll usually need to fast for at least five hours before the procedure, depending on the time of day you get it done.
The average cost for a gastroscopy is around $1,350. This doesn't include out-patient costs or out-of-pocket expenses like assistants, anaesthetists, diagnostics or doctors' costs. With this included, costs are more likely to be around $2,000 to $3,000.
How is gastroscopy covered by health insurance?
You have two options when it comes to getting health cover for gastroscopy.
Private health insurance
You can get cover for gastroscopy with all bronze tier hospital policies. Bronze cover usually costs around $20 a week and should cover gastrointestinal endoscopy. Most policies come with a two-month waiting period if you don't already have similar cover, so you'll get to see a doctor quickly. If you have a pre-existing condition, the waiting period is 12 months.
Check with your health provider before the procedure to find out how much they will cover. Ask them about potential out-of-pocket expenses, such as consultation fees, doctor fees and nursing fees, as well as any anaesthesia fees in relation to the procedure. That way, you'll be able to work out whether you will have any out-of-pocket expenses and how much they will be. Depending on factors like your excess, insurance provider, doctor and hospital fees, you could be looking at around $40 to $150 for out-of-pocket expenses.
The Medical Benefits Schedule (MBS) code for gastroscopy is 30473 and 30478 and the MBS fee is currently at $249.50. However, your doctor doesn't need to adhere to the MBS fee. This means that when accompanied by things like consultations, anaesthesia fees, nursing fees and hospital fees, it could cost considerably more. In some cases, Medicare will cover most of the costs and you will have very little out-of-pocket expenses, so make sure you do your research beforehand. Ask your doctor about costs and check that you're covered by Medicare.
Waiting times for the procedure can vary and can depend on whether you are categorised under category two or three. If it's the latter, you could be waiting up to 12 months for a gastroscopy.
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