Public or Private (please help!!)

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.
Thanks
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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.
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
A surgeon should give you an estimate of the costs.
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.
Anne
All the best with your decision-making and your treatment. Hugs.
We all have varing experiences. Have you been referred to someone yet?