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What if I need a colonoscopy?

Need a colonoscopy? We look at how the private and public systems compare when it comes to out-of-pocket costs, waiting times and choice of specialist.

Colonoscopies are a common procedure used to diagnose gut problems, including the cause of abdominal pain and bleeding, as well as checking for bowel cancer after a positive result from a faecal occult blood test.

In fact, our claims data shows that 94,190 Medibank members had the procedure last financial year.

While you can get a colonoscopy in either the public or private system, there may be some differences in the experience you’ll have in each. Here, we explain the key differences between the two systems.

How long you’ll wait

As a public patient in a public hospital you may need to go on a waiting list for a colonoscopy. How long you’ll wait usually depends on how urgent your case is, and demand for colonoscopies at the hospital you’ve been referred to. If you are having a colonoscopy in the public system, the best way to know how long you’ll wait is by speaking to the specialist or hospital you’ve been referred to by your GP.

In the private system, you will usually be able to book a time that suits you and your specialist. If you have health insurance, it’s likely your insurer will pay benefits towards most of the cost of a colonoscopy, however it’s always best to double check with your provider.

If you do not have health insurance but wish to be seen as soon as possible, you can opt to have the procedure through the private system, however you would need to cover a large portion of the costs yourself.

Choosing your own specialist

In the public system, you’ll be assigned a specialist for your procedure. One of the perks of being a private patient is that you’re able to select your own specialist. While this isn’t necessary for everyone, those with certain health issues like bowel cancer or Crohn’s disease may have greater peace of mind knowing they can choose a particular specialist. Additionally, patients who have been living with their condition for some time may wish to choose a specialist they already know and trust for the procedure.

Out-of-pocket expenses

As a public patient in a public hospital or clinic, you’ll generally have little to no out-of-pocket expenses for treatment, as the procedure is covered by Medicare. However, for those in the private system, while your health insurance policy generally covers most of the cost of your procedure, you are likely to face out-of-pocket costs, depending on your excess, how much your doctor and hospital charge. If you are having a colonoscopy through the private system, be sure to ask your doctor, hospital and insurer what your out-of-pockets are likely to be before your procedure.

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