Private health insurance for polycystic ovary syndrome (PCOS) treatment

Getting a PCOS diagnosis can be quite difficult, as the syndrome has a wide range of symptoms and you may not display them all.³ You’ll most likely need a blood test or an ultrasound before you can get a diagnosis from your healthcare provider.

The primary PCOS symptoms include:³

• Hormonal imbalance. This may present as excess hair growth (hirsutism) or hair loss, acne or oily skin and more.
• Irregular menstrual cycles. Such as absent or irregular periods.
• Polycystic ovaries. Usually detected through an ultrasound, polycystic ovaries are typically larger than average-sized ovaries with small cysts around their edge.

If you are concerned you might have PCOS, it’s a good idea to talk to your GP. They can evaluate your family history, chart out menstruations and more. Following this consultation, PCOS can be diagnosed with a blood test to check hormone levels and an ultrasound to look for cysts.

PCOS symptoms have been known to increase in severity among those with obesity.¹ With an extras cover policy, you may be able to get more affordable access to dieticians and gym memberships. Managing this early can often make a big difference to your experience with PCOS, as weight gain is both a symptom of PCOS and a major influence in the severity of its other symptoms.

Furthermore, Medicare administers the Pharmaceutical Benefits Scheme (PBS) to subsidise the cost of various of medications. However, in some instances, your doctor may recommend certain medications that aren’t listed on the PBS. In this case, an extras policy may cover some of the cost of these medications. This could include hormones to ensure a regular period or to help you conceive a child.

Some women may find it difficult to cope with PCOS, so an extras policy may help cover the cost of an appointment with a psychologist for mental health support. If you’re struggling with PCOS, you should discuss this with your GP to determine the best course of action for your situation.

If you require day surgery to examine or treat your PCOS, private hospital insurance could help cover your costs as a private inpatient, avoid public waiting lists and let you choose your own available specialists.

When you’re treated privately, you can usually choose your own available doctor when you’re treated as an inpatient, one who you’re confident is familiar with your condition. For women looking to conceive, the ‘Pregnancy and Birth’ clinical category is only required to be covered under Gold tier hospital cover policies. However, depending on the health fund and policy, some insurers may opt to include the ‘Pregnancy and Birth’ clinical category within a lower tier of cover, for example, within a Silver Plus tier policy. It’s therefore important to check the inclusions listed within your policy.

Some women who are suffering from severe PCOS and don’t plan on having children might consider having their ovaries removed (on their doctor’s advice). Such surgery falls under the clinical category ‘Gynaecology’, which is a minimum inclusion on Bronze, Silver and Gold tier hospital policies.

It’s possible that PCOS will be considered a pre-existing condition by your health insurance provider. However, this won’t affect your eligibility for a hospital insurance policy or increase your premiums. If you’re deemed to have a pre-existing condition requiring inpatient hospital treatment, it will only affect the waiting period you need to serve before you can claim on treatment relating to your condition.

A pre-existing condition is an ailment, illness or condition which, in the opinion of a medical practitioner appointed by your insurer, existed any time during the six months prior to taking out hospital cover or upgrading to a higher level of hospital cover. When upgrading to a higher level of cover, any waiting periods you have already served will be recognised by your new fund. You will, however, be required to wait for any new or upgraded services and benefits.