Public or Private (please help!!)

maddi Member Posts: 7
edited September 2019 in General discussion
After diagnosis of High Grade DCIS with Mastectomy required. My husband and I are both on the aged pension, and have struggled to maintain private health insurance. I live in a rural area which has no access to reconstruction surgery in the private or public system so I need to go to Melbourne. What worries me a lot is the gap fees if I have to go private because of the need to act fairly quickly. I would love to chat with anyone that can help me with information on how it all works and any idea of the cost process.


  • CRM
    CRM Member Posts: 92
    Hi Maddi... I'm not sure about the cost of mastectomy. But I have top hospital cover and I only paid the $500 insurance excess for my lumpectomy at the Women's hospital in Melbourne. No gap fee. My surgeon was Bruce Mann. 
  • Anne65
    Anne65 Member Posts: 425
    @maddi I had lumpectomy surgery for DCIS in a private hospital in Adelaide - St Andrews. I had Hospital Cover & the only fee I had to pay was my insurance excess (like @CRM ). I had NO gap or any other costs to pay for the tests/surgery/medication involved with my DCIS. I believe it depends heavily on which surgeon you go with so ask them what their fee structure is so you are aware of what payment, if any, needs to be paid. It doesnt seem fair that all surgeons work differently when it comes to their fee structure but we are well within our rights to ask & if need be, see another surgeon if it means a cost saving to you. Good Luck. xx
  • primek
    primek Member Posts: 5,392
    I live in a rural area and went public. Surgery etc only done 500k away. I had a reconstruction via public. No cost. If you do have private though you can still go public and just choose to use it with no gap. Cancer council hopefully have accommodation available near the hospital referred to and you can claim back on isolated patients. Have you a breast care nurse?...they can help you with this.
  • Lisa1407
    Lisa1407 Member Posts: 258
    Hi Maddi
    For breast cancer related surgery, for me it is a no brainer - go public or use your private insurance in a public hospital (where the public hospital pays any gap fee on your behalf). The later seems to be what CRM above used at RMH. At least in Melbourne, the public hospitals like Peter Mac and RMH have excellent surgeons. I myself am a patient at Peter Mac where I had my breast removed by an excellent breast surgeon and then around 18 months later I had a reconstruction (DIEP Flap - if I had have wanted implants that would have happened more quickly) at Peter Mac with a plastic surgeon who works mostly in the private sector but offers a day per week at Peter Mac. I paid the hospital excess of $500 as I went in as private patient in public hospital (where I could choose what doctor I was under). I haven't paid a cent since then for surgery related stuff. I am on the wait list for a revision to my reconstruction (just to make it perfect) and will not pay anything for that either. Surgeon is even going to throw in a bit of lipo suction of my hips! For a mastectomy (and a reconstruction at the same time) you will not wait long due to the urgency of removing the cancer. If you have a reconstruction further down the track, you may need to wait for up to 12 months. My wait for the revision to my reconstruction will be a bit longer than 12 months I think, but I am not worried by the wait! Good luck with your decision.
  • Blossom1961
    Blossom1961 Member Posts: 2,430
    @maddi I went public. I was seen very quickly after diagnosis. I do not think my treatment would have been any different if I had gone private. I had to fork out for scripts medicine and also my breast ultrasounds, biopsies, mammograms as I had these done in a private clinic not the hospital. All up around $2000. My GP started bulk billing me as soon as I was diagnosed. All other tests were free.
  • arpie
    arpie Member Posts: 7,806
    Hi @maddi - It sounds like @CRM had a 'good deal' - so her surgeon may be the one to try & get your appointments with?   Do you have someone to accompany you to all your appointments (as a 2nd set of ears and emotional support?)  It is all such a whirlwind thing - it can be difficult to remember everything that is said.  Even record the conversation as well, for later referral!

    I had my surgery done private & ended up about $6000 out of pocket (with medications etc), which really surprised me - but all my mammograms, ultrasound, biopsies etc were either free or 'reasonable' gaps to $80. My main gap was my NSW surgeon (but he was the best) & then I was surprised that my hospital pathology wasn't gap free - there was a $500 gap there!  And the hospital excess of $200 plus another $400 fee as it wasn't on my health fund's list of approved hospital! (The excess was just the 'one-off', no matter how often I was admitted within a 12 month period - not that I used it again!)  

    Being rural - Vic also should have some sort of 'assisted Patient Transport System' set up - where you fill in some forms & get your GP &/or surgeon to sign them & fill in their bit - and the Gov reimburses you a specific number 'cents per kilometre' to offset the cost of travel.  They also subsidise any accommodation you may need for your appointments/treatment as well.  There is often a time limit of 12 months to claim on these, so well worth getting some copies printed off & taking one with you every time you go to Melbourne (2 copies if staying in paid accommodation as well.)

    When I had my radiation in the public system for no cost, I 'lived in' at the hospital in their Rotary Lodge (in NSW) and the cost was minimal & I didn't have to drive 1.5hrs each way every day for treatment.  I almost treated it as a holiday, until my husband fell over & broke a rib - then HE was the patient, not me!  grrrr

    Don't be afraid to ask the surgeon & other specialists what their gap fee is & if as a pensioner they would 'waive it' for you.  If you don't ask - you don't get!  Some of the specialists/surgeons also work in the public system as well as private, so have the 2 operating lists.  Sometimes waiting for public with the surgeon of your choice 'may' take a little longer - but a week or two is unlikely to make any difference to your diagnosis - but could save you heaps of $$.

    take care & all the best with your decision making. xxxx
  • Glynnis
    Glynnis Member Posts: 354
    @maddie when I had my lumpectomy done in 2015, I had top cover so went private only things I paid for were the excess of $500 and meds, it also covered my chemo. Now I have just enough cover to deal with the cancer a nd heart etc but am under the public system for my oncologist so will stick with that I think should I need too, have been consider dropping the private cover for a while now.
  • youngdogmum
    youngdogmum Member Posts: 250
    I have only ever had public care and can't fault it at all, I've never held insurance. I am probably purchasing it to have my reconstitution; I chose immediate mastectomy and delayed recon. This is because the wait to have it done public is probably pushing 2-2.5 years and as a young woman wanting to crack on with my recon a bit sooner. 
    A surgeon should give you an estimate of the costs.
  • Sister
    Sister Member Posts: 4,960
    I had top cover but little income which I was upfront with my surgeon about.  He took this into consideration with anaesthetist and gap.  Small gap for him, no gap with anaesthetist.  Private hospital with the excess I had to pay.  Oncologist is private and chemo covered as inpatient.  Radiation definitely choose public as it is not covered by health funds at all.
  • BlackWidow
    BlackWidow Member Posts: 268
    Hi @maddie
    Being in the same boat as you (western Vic Rural, pensioner, but have paid private cover for many years) my high grade extensive DCIS required a very quick mastectomy.  I could go Regional for the mastectomy and later found I could have had some reconstruction but my choice of a DIEP would have meant Melbourne.
    The surgeon waived all fees for going private but I was out of pocket for the anesthetic, the usual gap at the hospital and some smaller costs.
    A Melbourne DIEP would have been around $20k out of pocket with using my private cover, though.  That was out of the question.
    If you prefer a private room and the comfort that provides then go that way as i did.  I prefer to see the same specialist each visit.
    If the public hospital is a teaching hospital the hospital can over-ride the surgeon and you could have students (with the surgeon supervising) doing the surgery on the day.
    Hope this helps.  All the best.
  • kmakm
    kmakm Member Posts: 7,974
    I went private, ignorantly and in haste. Despite having private health insurance it's cost me a lot of money. If I had a do over, I'd try to do the private patient in a public hospital thing. Tbh I still don't really fully understand how all this stuff works. It seems like a minefield to me.
  • Flaneuse
    Flaneuse Member Posts: 899
    @maddi  I've had everything done in the public system in Qld. at no cost except parking and prescriptions. In fact, most medications during chemo were free (I'm a pensioner too). Also - going by what I've read on this forum, some people who go private are daunted by the potential cost of additional tests & scans and don't 'automatically' have them. In the public system, I was sausaged through every possible test before and after surgery - top-to-toe bone scan, CT scan(&follow-up tests for spots on my liver & thyroid and I'm now in the system forever to keep checking my thyroid), MRIs, ultrasounds, biopsies, X-rays, electro-cardiogram, blood tests, chemo (and when I got an infection during the first cycle they gave me the special injection - worth well over $1000 - free for the next time), radiation (and the radiation oncologist gave me free StrataSRT gel), etc. etc. Also, I now have an ongoing relationship with the public system, which has huge benefits. Just over four weeks ago, I had my revision surgery to have my problematic reconstruction removed - having successfully self-advocated to change my surgeon - and am very pleased with the results. However, an infection developed in my wound after a couple of weeks and I emailed photos to the BC nurse, who immediately rang me and said yes, it's an infection - go to GP and get ABs and I'm making an appointment for you to see the surgeon on Monday. When I went in, he identified a seroma and drained it immediately to avoid complications if the infection spread to it. He said to take more courses of ABs and he made an appointment for me to come back to him in two weeks. These are the things we've paid our taxes for, for all those decades. 
    All the best with your decision-making and your treatment. Hugs.
  • Romla
    Romla Member Posts: 2,092
    I support going public for radiotherapy .You can blend private and public treatment eg private surgery and public radiotherapy.I had private radiotherapy and only 3 weeks - am in top private health and was out of pocket more than $2000 many on here with longer treatment have paid much more.The radiotherapy treatment is the same public/private with bar the initial mapping appointment taking around 15 minutes per session - the lengthiest bit of my radiotherapy treatment was finding a car park.
  • Romla
    Romla Member Posts: 2,092
    PS With the benefit of hindsight I’d probably go as a private patient in a public hospital for surgery. My breast surgeon practices both in the private and public systems and tbh I have learnt the after surgery support is much better in public system - once I paid in the top private hospital they had no further interest unlike others I know who went public.
  • iserbrown
    iserbrown Member Posts: 5,606
    I went private and my surgeon has his team so I was taken care of by his breast care nurses and physio. The breast care nurses followed up once I was home and even today 4 years down the track they are accessible if I have concerns.  Recently I had contact and she was very happy to help and encourage me to ring again if I feel the need.

    We all have varing experiences. Have you been referred to someone yet?