public system or private health insurance?

IlovehuskiesIlovehuskies Member Posts: 6
edited December 2016 in Newly diagnosed
I am 55 and just got diagnosed with high grade DCIS (2 lesions, one with focus suspicions for micro invasions, lymph node U/S FNA - Negative). the hospital gave me a referral for their breast surgeon for mid December but also notified my doctor. My doctor called me and asked me to come in for a chat and she wants me to go private so the mastectomy can be done before Christmas (which most likely can't be done in the Public Hospital, they start with surgeries again on the 10th of January). I am now really confused what to do, while I would love to have the surgery out of the way as soon as possible, I am worried with GAP payments if I go private. I don't have yet an appointment for the private surgeon but my doctor reckons I could get one for this coming week. 
while I am extremely lucky that I was diagnosed early, it's still a shock and I am confused and worried.
if anyone could let me know about their decisions and costs for GAP payments, I would really appreciate it.
thank you :) 


  • JanineGJanineG Melbourne (west)Member Posts: 117
    Hi. How awful you have to make this decision. I live in Melbourne and my surgery and follow up care has been with the Royal Melbourne, plus the Women's and Peter Mac. I didn't have private cover so everything has been public. The service amazing. I am so greatfull for the care I've received. No out of pocket. 
    A close friend however chose to use her private cover. Her treatment was no better or faster than mine and financially very hard for the family. She was out of pocket $1000's in the first months. It's made things tuff with her not being able to work. 
    Not sure where you live but if you have a breast care nurse they are fantastic at providing guidance. Maybe don't make decisions until you are confident with the choice. 
    All the best xxo

  • NadiNadi Member Posts: 558
    Hi. I was pretty much in the same boat tossing up whether to go public or private for surgery when I was diagnosed with Grade 3 HER2 positive invasive ductal carcinoma with a proliferation rate of 71% (anything over 25% was considered high). Having to pay the gap was an issue for me but even more of an issue was my psychological need to keep my nipple. In the end I opted to go private because I wanted a particular surgeon who specialised in nipple conserving surgery. I ended up about $4000 out of pocket for that particular surgery which was a lumpectomy and reconstruction using my own breast tissue. I couldn't wait because it was classed as extremely aggressive and HER2 positive. My mother in law was diagnosed with DCIS and they told  her it wasn't  as urgent that she have surgery so she took a bit longer to make a decision. I think it comes down to how comfortable you feel with the surgeon. How much the GAP will be will be very different depending on the type of surgery and the surgeon. Good luck with it.
  • melclaritymelclarity Member Posts: 3,078

    Hello! Im so sorry to hear of your diagnosis, my question is who has said you need a Mastectomy? did you have surgery already as in a lumpectomy, is that how they got the pathology? or did they ascertain that through a biopsy? For Public Hospitals they have 3 categories, 1 being the most urgent and you would be placed at the top of the list which would get you in before Christmas. Have you seen a Specialist or only your GP regarding your results, as I think a Surgeon is definitely the one to talk to about all of it. My surgeon is private through Freemasons in Victoria, but also works in the Public System. I went private in 2011 and 2015 for lumpectomies and apart from my excess for the year and the Anaesthetist the hospital was covered. I am now scheduled however post Chemo for a mastectomy/reconstruction using my Surgeon plus a Plastic Surgeon and they are putting me through the public system as there will be no cost and he's placed me as Category 2 so within 90 days. I had a recurrence, Grade 2, Stage 3 aggressive, lymph node clearance. I have negative BRCA Gene, and am ER+ only and on Arimidex. If I went private and elected it, Id be out of pocket approx $10,000 inclusive of Anaesthetist whose bill is $4,000 ridiculous!!! So you really need to see a Surgeon to make a choice, public or private and more importantly discuss with confidence your diagnosis, treatment with a reputable Surgeon. Hugs Melinda xo
  • primekprimek Broken HillMember Posts: 4,320
    Mid December  is not far away and being dcis I think an early January surgery is not a long wait. i know of  women who have paid thousands of dollars for  their surgery over their health fund cover. meanwhile you can start to think of options...lumpectomy or mastectomy, reconstruction or not. This way when you have the talk with the surgeon you at least have heard and know  of options. I had invasive bc biopsied 17th Dec, results back 29th. Appt. Jan 5th and surgery bilatetal mastectomy with tissue expander reconstruction done 20 days later. in between I had mri scans, bone scans, ct scans and my pre op workup. Ask your breast surgeon about your concerns of a delay in surgery. GPs don't have all the details or knowledge that a breast surgeon has. Take care. Kath x
  • BevkkBevkk Member Posts: 22
    I was given the choice of either public or private by my surgeon as he did both. I chose private as he didn't charge any gap nor did his anaesthetist. Check on your health cover website for the list of provider surgeons. I chose the surgeon who works with breast screen Australia in consultation with a multidisciplinary team who discussed my case and came up with the best way to treat me. It has only cost me the hospital co payment for surgery and all chemo treatment has been free. All scans, blood tests etc have also been free. Hope all goes well for you
  • Hopes_and_DreamsHopes_and_Dreams Gold CoastMember Posts: 752
    Hi, I'm so sorry for your diagnosis.  So many decisions to make and all the information can be overwhelming.  I had an invasive ductal carcinoma in July picked up in a routine mammogram. I'm also 55. I have known my GP for over 30 years so he was the first person I went to after getting my biopsy results.  Sadly his wife had the same type of breast cancer 12 months before.  She was happy with the surgeon they chose so that was a pretty good recommendation for me. He specialises in only breast cancer and breast cosmetic surgery & operates out of a private hospital. I went private as I wanted this surgeon to treat me. He gave me all the options and honest info re outcomes and expectations. I had a left nipple sparing mastectomy with immediate silicon implant, 3 lymph nodes removed, all sorts of pec muscle cuts and repairs. This cost around $7500 with out of pocket approx $4000. The anaesthetist only left me with a gap of $500, not too bad for 4hrs surgery. All my follow up consultations to the surgeon were covered in his surgery cost.  I have absolutely no doubt that I would have received equally amazing care had I gone public but for me it came down to wanting a particular surgeon. As other ladies have said, there are a lot of other expenses not covered by private health. The MRI was $500 alone! 
    I was fortunate not to need any further treatment (1.3cm grade 1, clear margins, clear lymphs) and am happy with the reconstruction, a good size/shape match to my healthy breast.
    Make a note of all the questions you have, even if you think they are silly. Otherwise it's so easy to forget half of them during the consultation when you have information overload!  Don't forget to ask questions here too - we have all had different experiences and the ladies have so much to share.   Good luck, wishing you all the best with your decisions.  Jane xx
  • IlovehuskiesIlovehuskies Member Posts: 6
    thanks for your responses and well wishes! I checked the provider surgeons for Medibank in WA and there don't seem to be any :( 
    @melclarity - due to the size of the 2 lesions and how they are connected (and the size of my breast), mastectomy is the best option. 
    I think I will go public as I don't know anyone who had surgery done and can recommend a private surgeon. the gap payment is a worry even we have top cover through my husband's work. 
    I am also not sure if I want reconstruction or not. I was always thinking I would like to have reconstruction in the case of a mastectomy (both my mum and mother in law had breast cancer, my mum had lumpectomy and my mother in law mastectomy with no reconstruction). but having now seen some photos of reconstruction, I am not sure what to do. I guess I will go for the appointment with the hospital breast surgeon and discuss my options then.
    thanks again to all of you for your help <3

  • melclaritymelclarity Member Posts: 3,078

    I think thats a good choice in this moment, I think you do have the time and yes makes sense based on 2 lesions. I just wanted to point out too though, as in my case I did get to choose my Surgeon as I am a Private patient and have been seeing him privately for 5yrs, but he also works through the public system as well, this is why he offered this option purely to save me my money. He said the care is second to none and he's a reputable well known Surgeon in Melbourne, Id recommend him to anyone. As long as they are a specialist in the field of Breast Cancer, surgery, reconstruction is whats important. Hugs Melinda xo
  • IlovehuskiesIlovehuskies Member Posts: 6
    I went and saw the private surgeon my GP recommended and guess what, she does both private (without any gap payments) and public. I ended up going as a public patient as I had to stay only one night in hospital (and a lot less paperwork) and mastectomy was on the 15th of December. 
    they removed 2 sentinel lymph nodes and now it's a LONG wait until I will get the results due to the Xmas break. I have an appointment on the 10th of January, almost 4 weeks after mastectomy  :(

  • primekprimek Broken HillMember Posts: 4,320
    Yes a long wait but you'll have your plan layed out then too so you'll know very doon tbe rest of your treatment. It will be happening quickly now. Kath x
  • Lizzie13Lizzie13 Dragonfly Posts: 46
    I have private insurance and was not worried about the Gap financially but I chose to go public. I am a registered nurse and have worked in senior roles in both private and public health management and would always chose public over private with something as serious as a mastectomy. both my surgeon and oncologist are both private and public and I am seen as a private patient in the public system and it works well for me. The only annoyance is the wait times for clinics sometimes.
    I sadly developed mets 3 yrs after my mastectomy and was glad that I was public as I had the opportunity of going onto an amazing trial with immunotherapy.
    I think you have made the right choice with public - just see if you can be a private patient in the public system - gives you a few more benefits (like a private room if there is one available) and does not cost you anything.

  • IlovehuskiesIlovehuskies Member Posts: 6
    thanks for the advice, Lizzie! 
    wishing you all the best for your trial 
  • melclaritymelclarity Member Posts: 3,078
    @Ilovehuskies Im so glad you found it helpful! and found a private Surgeon that goes Public as well. Fantastic!!! Im waiting on my call in the next month for the Mastectomy as am going Public, Im going as a public patient however on both Surgeons recommendations. As I dont have any out of pocket, unfortunately my Health Fund would not have contributed alot as alot deem reconstruction as cosmetic. Hoping it all works out! Keep healing and resting and let us know how your results go. Hugs Melinda xo
  • Lizzie13Lizzie13 Dragonfly Posts: 46
    edited December 2016
    @melclarity remember you can go privately within the public system, that is you can be a private patient in a public hospital, it does not cost you anything but you do get some benefits.
  • melclaritymelclarity Member Posts: 3,078
    Hey Lizzie, yes I know and i would have preferred it but i would have had out of pocket for hospital excess. My surgeons said to go public. I really wanted my own room. Ill ask when they have a date for me. Thanks. Melinda 
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