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Health insurance for hysterectomy surgery

If you need a hysterectomy, here's how to find the right level of health insurance.

Without the proper cover, hysterectomy surgery can set you back over $12,000 in Australia. There are several different types of hysterectomy, including laparoscopic, abdominal, partial and total hysterectomy, all of which can vary significantly in price.

You're probably considering a hysterectomy if your doctor or gynaecologist has explored all other options. As one of the most common types of elective operations performed on women in Australia, it's crucial you know what your insurer covers and the out of pocket expenses.

What is a hysterectomy?

A hysterectomy involves the removal of the womb (uterus), with or without the cervix. The operation can also include the removal of the ovaries and the fallopian tubes.

If you have a hysterectomy, you will no longer have periods and won't be able to have a child.

Common reasons for a hysterectomy include:

  • Fibroids – benign tumours, sometimes also referred to as myomas.
  • Cancer of the cervix, uterus, ovaries or fallopian tubes.
  • Menstrual problems such as very heavy bleeding or extreme pain.
  • Endometriosis – uterine glands that grow in other pelvic tissues.
  • Pelvic inflammatory disease.
  • Uterine prolapse – when the uterus pushes into the vagina.

Of these, fibroids are the most common reason for a hysterectomy. You will need to stay overnight in hospital and can expect to be there for between 2 and 7 days depending on your circumstances and the type of surgery you have.

How does Medicare cover hysterectomy surgery?

With Medicare, there are little to no out of pocket expenses for hysterectomy surgery if you are a registered public patient and have surgery in a public hospital. If you are a public patient in a private hospital, Medicare will cover 75% of the bill, so you could face up to $3,000 worth of out of pocket expenses.

If you decide to use the public healthcare system, it's worth noting that waiting periods for a hysterectomy can be very long; the average public hospital wait is 54 days. Depending on how quickly you need to have surgery, you may consider going private for speedier treatment.

You are also unable to choose your own doctor or consultation times. If having your own doctor will provide you with greater peace of mind or you have a busy schedule, then treatment as a private patient is probably more suited to you.

How to claim the Medicare rebate

You can claim your Medicare rebate using your Medicare online account. This can be accessed through myGov. Speak to your doctor or call a Medicare consultant if you can't access it online. If you elect to have surgery through Medicare, make sure you get your rebate or you could be looking at paying for the entire surgery. Remember though, Medicare will cover 75% of costs in certain cases so the rebate will still leave you with a bill.

How does private health insurance cover a hysterectomy?

If you decide to go private, a hysterectomy will usually come under a medium level of hospital cover. The average waiting time for surgery in a private hospital is 28 days.

Whilst many product disclosure statements (PDS) explicitly state that they cover "hysterectomy surgery", it can sometimes be listed under "gynaecological procedures". If this is the case, you need to make sure that hysterectomy treatment is included in your policy.

You should also make sure your policy covers the specific type of surgery you need as many only include vaginal or abdominal hysterectomies. Make sure you do this well in advance of surgery, or you put yourself at risk of paying for everything.

Unless you have no gap, there will be some out of pocket expenses for a hysterectomy which are likely to be around $500, depending on your cover. Because you have a lot more control with private healthcare, you can really lower costs. The amount really depends on the decisions you make, from your excess to your choice of hospital and doctor. If you do your research beforehand, you're guaranteed to get the best value for your money with private healthcare.

What do different insurers offer for a hysterectomy?

Below are some examples from Finder that cover gynaecological procedures including hysterectomy. All quotes are based on a singles hospital policy in Sydney, NSW. If you've never had health insurance before, you will have to wait 12 months before you can claim. But if you're switching, you won't have to serve the same waiting period twice.

Fund Policy Cost per month Apply

HCF

Mid Hospital $101.25 Go to Site
ahm logo

ahm

White Classic $105.43 Go to Site

Health Insurance Reforms coming April 2019

As part of the reforms to the Australian health insurance system, we will see hospital policies placed in four categories: gold, silver, bronze and basic.

Each of these tiers includes cover for a minimum number of clinical categories. If you wish to continue to claim benefits for hysterectomies, you will need a policy of Bronze tier or higher.

How much will I be out of pocket?

If you have surgery as a public patient in a private hospital, you will need to pay 25% of the total cost, including extras. This could lead to you paying thousands of dollars. Indeed, gap payments of $2,000 or more are becoming increasingly common, according to the Australian Prudential Regulatory Authority, so be sure to avoid this.

If you opt to go private, you'll likely receive some out of pocket costs depending on the range of services that are covered by your policy, as well as your excess.

Whereas in an emergency you can't control which hospital or surgeon performs your procedure, it's very often that you know well in advance if you need a hysterectomy. That's why it's crucial you do your research beforehand. There are a number of things you can do to work out your estimate:

  • Call your surgeon to get a cost estimate.
  • Ask if your surgeon is in your private health insurance provider's preferred list to help find the most affordable option.
  • Ask for your surgeons extras cost; things like an anaesthetist can cost a lot.
  • Make sure there are no hidden out of pocket expenses like x-rays.
  • Ask for your Medicare code.
  • Call your private health insurance provider and give them your Medicare code.
  • Call the anaesthetist and ask them for a cost estimate.
  • Find out your doctor's estimated rebate.

What are the different types of hysterectomy?

This type of hysterectomy involves removing both the uterus and the cervix. The majority of women undergoing hysterectomies have a total hysterectomy.

In this case, the uterus is removed but the cervix is left in place. A partial hysterectomy can help to reduce sex-related consequences. If the cervix is kept, regular cervical screening is still necessary. The surgery can be performed laparoscopically or abdominally.

This is a minimally invasive procedure using a laparoscope, a small telescope-like instrument with a camera at the end. The surgeon will insert this to see your pelvic organs by making a small incision in your navel. They will then make three or four small incisions through which other instruments are used. The surgeon will remove the uterus in pieces – and may also remove the fallopian tubes and ovaries if necessary – either through the incisions or the vagina.

For an abdominal hysterectomy, the surgeon will usually make a vertical or horizontal incision along your abdomen. For most women, this will leave a small scar.

This is usually performed when there are adhesions or if the uterus is very large. It's also generally recommended when a woman has very large fibroids or cancer. You will probably need a longer stay in the hospital for an abdominal hysterectomy.

A vaginal hysterectomy is performed through an incision at the top of the vagina. It is usually performed when there is a uterine prolapse. It is performed entirely through the vagina, so you won't be left with any scars and should expect a shorter hospital stay.

What are the side effects of a hysterectomy?

Although most women don't develop side effects after a hysterectomy, they can include:

  • Injury to nearby organs.
  • Anaesthesia problems, such as breathing or heart problems.
  • Blood clots in the legs or lungs.
  • Infection and/or heavy bleeding, especially if you are overweight.
  • Internal haemorrhage.
  • Difficulties with urination.
  • Internal scar tissue.
  • Early menopause, only if the ovaries are removed.
  • Pain during sexual intercourse or decreased sexual desire.

Compare your private health insurance options

Want to explore more options for private cover? Simply enter your details below and compare Australian health funds side by side.

Picture: Shutterstock

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