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Health Insurance For Endometriosis

Chris Stanley

Updated 30/04/2021

Health

Private Health Insurance For Endometriosis

More than 14% of Australian girls and women will experience endometriosis at some point in their lives.

With so many people affected by the chronic condition, securing the best private health insurance for endometriosis is critical.

Key Points

Endometriosis is treated with pharmaceutical, surgical and complementary therapies.
Patients with health insurance typically pay around $560 in out-of-pocket expenses
Medicare covers 75% of the surgery schedule fee as listed in the Medicare Benefits Schedule.
The average waiting time for endometriosis surgery in a public hospital is 78 days.

What is endometriosis?

Endometriosis is a chronic condition that occurs when endometrial tissue grows outside the uterus, including on the ovaries, fallopian tubes and other pelvic organs. This tissue growth can also develop outside the pelvic area.

Diagnosis of endometriosis often involves a medical history review, pelvic examinations, an ultrasound, and, in some cases, laparoscopic surgery.

Symptoms of endometriosis can include:

Pelvic pain
Painful periods
Pain during or after sex
Painful bowel movements or urination
Excessive menstrual bleeding
Infertility

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How is endometriosis treated?

The treatment of endometriosis often depends on the severity of the symptoms, the extent of the condition, and whether a woman is trying to conceive.

Treatment options aim to alleviate pain, manage symptoms, and, if relevant to the patient, improve fertility.

A combination of pharmaceutical, surgical, and complementary therapies may be used to treat endometriosis.

Pharmaceutical	Surgical	Complementary
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help manage pain and inflammation associated with endometriosis.	Laparoscopic surgery may be recommended to remove endometrial tissue and adhesions. This can provide relief from symptoms and improve fertility.	Pelvic floor physical therapy may help to manage pelvic pain and discomfort associated with endometriosis.
Hormonal contraceptives, such as birth control pills, patches, or rings, may be used to help regulate the menstrual cycle and reduce pain.	In severe cases, a hysterectomy that removes the uterus may be suggested as a last resort when all other treatments have failed.	Acupuncture may ease some endometriosis pain. However, scientific research on the effectiveness of acupuncture for endometriosis is limited.
Progestin-only and gonadotropin-releasing hormone (GnRH) medications, including oral contraceptives, injections, or intrauterine devices (IUDs), can help control endometrial growth.	For women trying to conceive, in vitro fertilisation (IVF), may be recommended if endometriosis has caused infertility.	Vitamin B1, magnesium and omega-3 fatty acids may provide some support. However, it’s important to note that some supplements can affect pharmaceutical treatments, so always check with your doctor.

Does private health insurance cover endometriosis surgery?

Private health insurance for endometriosis usually covers laparoscopic surgery – check under ‘gynaecology’ to confirm that your policy covers your endometriosis surgery cost.

However, depending on the specifics of your policy, you may need to pay out-of-pocket expenses for surgery in a private hospital.

According to the Australian Department of Health and Aged Care, patients typically pay around $560 in out-of-pocket expenses for laparoscopic surgery in a private hospital.

Does Medicare cover endometriosis?

The short answer is yes. Medicare covers endometriosis-related surgery in public hospitals. However, Medicare will only pay 75% of the surgery schedule fee as listed in the Medicare Benefits Schedule (MBS) for surgery by your choice of surgeon.

So when it comes to answering the question ‘how much is endometriosis surgery?’, we need to consider the type of surgery required, the scheduled fee for each type of surgery, how much Medicare will cover, and how much you need to pay.

Laparoscopy for endometriosis cost* in Australia:

Type of surgery	MBS fee	Medicare pays	Patient pays
Excision or ablation of minimal endometriosis	$447.55	$335.70	$111.85
Excision of moderate endometriosis	$954.95	$716.25	$238.70
Hysterectomy or complex laparoscopic surgery	$1,845.25	$1,383.95	$461.30

* The MBS fee is the Medicare Benefit Schedule fee. Surgeons are free to charge above these amounts which may lead to higher out of pocket costs.

How long are waiting times for endometriosis surgery?

Public hospital waiting times for endometriosis-related surgery vary depending on the specific type of surgery required and the particular hospital, and change from year to year.

However, in 2021-22, the average waiting time for a laparoscopy in a public hospital was 78 days, while 7.7% of patients were forced to wait for more than 365 days.

Fortunately, appropriate private health insurance can drastically reduce that wait by allowing affordable treatment in a private hospital. If you have appropriate health insurance for endometriosis, you can typically choose your doctor and hospital, and skip public hospital waiting lists.

If you're struggling to understand how to best cover endometriosis, the friendly health insurance experts at Compare Club are here to help.

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Sources

Endometriosis Australia, About Endometriosis

Mayo Clinic, Endometriosis – Symptoms and Causes

Mayo Clinic, Endometriosis – Diagnosis and Treatment

Australian Government Department of Health and Aged Care, Laparoscopic Resection of Endometriosis

Australian Government Department of Health and Aged Care, MBS Online, Operative laparoscopy (35637)

Australian Government Department of Health and Aged Care, MBS Online, Excision of moderate endometriosis (35632)

Australian Government Department of Health and Aged Care, MBS Online, Hysterectomy, complex laparoscopic (35753)

Australian Institute of Health and Welfare, Waiting times of selected elective surgeries, all hospitalisations, 2021–22

Things You Should Know

*As our customer you'll be provided with quotes directly from the insurer for the product you intend to purchase. We manage the application and deal with the administration work and insurer. We do not charge you a fee for the service we provide, the insurer simply remunerates us in return for setting up your policy. The financial and insurance products compared on this website do not necessarily compare all features that may be relevant to you. Comparisons are made on the basis of price only and different products may have different features and different levels of coverage. Compare Club does not compare all policies available in Australia and our partner insurers may not make all policies available to Compare Club.

This guide is opinion only and should not be taken as medical or financial advice. Check with a financial/medical professional before making any decisions.

Chris Stanley is the sales & operations manager of health insurance at Compare Club. With extensive experience and expertise, Chris is a trusted leader known for his deep understanding of health insurance markets, policies, and coverage options. As the sales & operations manager of health insurance, Chris leads a team of dedicated professionals committed to helping individuals and families make informed decisions about their health insurance needs.

Meet our health insurance expert, Chris Stanley

Chris's top health insurance tips

1
Australia’s public health system is world-class, but wait times for public hospitals can be long, inconvenient - and leave you living in constant pain while you wait.
2
An appropriate private health insurance policy can speed up your surgery, relieving your pain sooner.
3
Family health cover means your children are covered under the same policy as you.
4
Many health insurance policies come with a 12-month waiting period for pregnancy-related cover, so it’s a good idea to get a family policy organized well before starting your family. This means your child will be covered from birth until at least their early twenties (depending on which health fund you select).