A colonoscopy is a procedure to inspect the large bowel, which might be necessary if you are at risk or show symptoms of bowel cancer or bowel disease.
For such a common procedure, the cost can vary. We’ll walk you through those costs and how health insurance can help you.
Colonoscopies are used to diagnose – and in some cases remove – bowel cancer. It involves a flexible tube known as a colonoscope which is inserted through the anus into the large bowel. Using a live camera feed, surgeons diagnose and remove any cancerous tissue.1
Symptoms of bowel cancer include:
Days before the procedure, you may be placed on a special diet and given laxatives to help clear out your bowel. Your GP or specialist will be able to walk you through the process. When undergoing a colonoscopy, you’ll be under sedation.
The average cost of a colonoscopy (with or without a biopsy) was $1,300 in the 2019-20 financial year, based on data from the Department of Health.3 The cost includes the doctor’s fees, surgery costs, theatre and anaesthetist fees plus any other expenses involved in a colonoscopy.
It’s essential to note that this price isn’t necessarily what you’ll have to pay, as colonoscopy costs can vary based on which hospital and doctor treats you.
Medicare (Australia’s public health system) covers the entire cost of a colonoscopy if you’re a publicly admitted patient. Once you’ve been referred to a specialist, you will be put on a public waiting list for a colonoscopy. Most patients in Australia’s public system (86.55%) have a colonoscopy within 30 days of seeing a specialist.4
Going through the private system for a colonoscopy means you can choose your doctor and be treated in a private hospital. You also avoid public waiting lists, which means you could be seen even sooner.
In the 2019-20 financial year, 81% of privately insured patients (who were covered for colonoscopy) didn’t have to pay anything out of pocket, as their health insurance covered all expenses (though they may have been charged an excess). Those who did pay had an average out-of-pocket cost of $170, according to the Department of Health.5
Medicare covers 75% of the Medicare Benefits Schedule fee for private patients, and private health funds cover the remaining 25%.
Doctors and specialists can set their own fees, which means there may be a gap payment to cover the difference between what doctors charge and what Medicare and private health insurance covers. 1
The Medicare Benefits Schedule (MBS) is a list of item numbers and corresponding prices for medical services and treatment covered by Medicare, which the Australian Government deems a fair amount to cover the cost of a procedure.
|MBS item number||MBS fee||Medicare covers 75%||Remaining 25% difference|
|32087, 32088, 32089, 32093||$213||$159.75||$53.25|
|32222, 32223, 32224, 32225, 32226||$347.90||$260.95||$86.95|
|Source: Medicare Benefits Schedule Book: Operating from July 2021. Department of Health, Australian Government. 2021.|
Remember, the listed fees are only a part of the total cost of treatment and expenses you might have to pay. For example, you may also have to pay excess payment for claiming on your private health insurance, or your doctor could set their fee higher than the MBS fee.
Hospital insurance is categorised into tiers of cover (Basic, Bronze, Silver and Gold), which are standard across all health insurers. Colonoscopies are a minimum requirement in Bronze category and above under the treatment category ‘gastrointestinal endoscopy’.
With health insurance for a colonoscopy, you’ll be covered for the following costs (provided you’ve sat through any waiting periods prior to claiming):
Some hospitals and specialists have an agreement with private health insurers where you won’t have any out of pocket payments for hospital fees, or you’ll know what the gap payment will be beforehand. These are known as no-gap and known-gap agreements.
Keep in mind, other doctors who may be involved in a colonoscopy might not have the same agreement with your health insurance provider (e.g. your anaesthesiologist). You may have out-of-pocket costs for any assisting health professionals, depending on whether they charge above the MBS-listed prices for the procedure.
Yes, you can use your private health insurance in a public hospital and be admitted as a private patient. In this instance, the hospital bills your health insurer the 25% difference that Medicare covers for public patients.
Also, most public hospitals are treated as agreement hospitals by private health funds when it comes to out of pocket costs, even if there is no formal agreement.
Regardless of whether you are going to a public or private hospital, make sure you ask your health insurer and the hospital about all potential out of pockets you may be charged for your treatment.
You’ll need to serve a two-month waiting period before you can claim on colonoscopy treatment. If you have shown any signs of symptoms of requiring a colonoscopy within six months of opening your private health insurance policy, you won’t be able to claim the cost as a private patient right away. In most cases this will be deemed a pre-existing condition by the insurer and will require you to serve a twelve-month waiting period.
If you switch over to a new health fund but maintain your current level of cover, you won’t need to re-serve any waiting periods you’ve already served. However, when switching policies or health funds without having finished a waiting period, you’ll simply pick up where you left off.
Private health insurance can be used to cover different medical costs and includes benefits such as:
If you’re thinking about taking out private health insurance, our free comparison service helps you weigh up multiple policies. In minutes, you can compare prices and take out a policy. Already have cover? We’ll help you compare and switch. Simples!