Endometriosis and your hospital cover
Did you know that it takes 6.5 years on average to be diagnosed with endometriosis? For a condition that affects more than 1 in 10 women, that’s not nearly fast enough. That’s why it’s worth learning about the disease. [1]
Endometriosis is when tissue similar to the lining of the uterus grows in other parts of the body. This endometriosis tissue fills and bleeds during a period causing inflammation and scarring. It can come with a range of symptoms including severe pelvic pain, fatigue and even causes fertility problems with about 1 in 3 women. [2]
To help doctors identify and assess endometriosis, patients can use the RATE tool from The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. For diagnosis and treatment, you may be referred to a gynaecologist after visiting your GP.
Common endometriosis hospital surgeries
Treatment for endometriosis can include hormone-based medication and surgery.
The latest government data a snapshot of how much health funds and members typically pay for hospital surgery to treat endometriosis. The figures are for private hospitals using the government’s Medical Cost Finder tool to show you the median cost (the middle) that health funds covered in the year to 1 July 2021.
The final column in the table below totals the health fund benefit average per surgery. Remember that half the surgeries cost more than the figures quoted.
| Surgery type | Description | Billing | Health fund benefits | |||||
|---|---|---|---|---|---|---|---|---|
| No gap % | Patient out-of-pocket costs | Specialist fees | Medicare specialist benefit | Specialist benefit | Accommodation, theatre and device benefit | Total health fund payment | ||
| Laparoscopy | Keyhole surgery on the womb to treat minimal endometriosis or scar tissue. The surgery may also be used as a form of permanent contraception. | 34 | $500 | $2600 | $1000 | $980 | $2600 | $3580 |
| Laparoscopic resection of endometriosis | Keyhole surgery to treat severe endometriosis. The surgery removes excess uterine tissue growing outside the womb in nearby parts of the body. The surgeon may use a specialised tube to look inside the uterus (hysteroscopy) and take a tissue sample for testing. | 26 | $550 | $4100 | $1700 | $1600 | $4300 | $5900 |
| Laparoscopic hysterectomy | Keyhole surgery to remove the womb and to take a tissue sample for testing. The surgery may include removal of one, or both, fallopian tubes and ovaries. It may otherwise treat moderate endometriosis or remove a cyst from ovary. | 32 | $550 | $3600 | $1300 | $1300 | $6600 | $7900 |
* All Australia, median data 2022 financial year
These figures come directly from the Australian Government Department of Health and Aged Care and reflect health funds overall, not just Peoplecare.
You can get a much more accurate estimate of planned surgery costs (if any) by asking your specialist for an itemised quote called Informed Financial Consent. Check out our Going to Hospital Guide for information on how to use our Access Gap scheme to save money on medical specialist fees in hospital.
Endometriosis resources
[1] endometriosisaustralia.org
[2] healthdirect.gov.au/endometriosis