I Thought Medicare And Private Health Insurance Worked — Then I Got A $5,000 Bill For Lifesaving Treatment

Lexi Laphor for Refinery29 Australia
I’ll preface this by saying: I’m not rich. Far from it. I am, however, fortunate enough that a $5,000 medical bill wouldn’t mean that I can’t pay my rent next month. But it would certainly hurt, especially because I’m an Australian citizen with access to (supposedly free) Medicare — and because I’ve paid for private health insurance for the last 7 years. I want to tell you about what happened to me in the hopes that it can help even one person save thousands of dollars on a medical bill.
I’ve always had heavy periods. Not your run-of-the-mill cramps; debilitating cramps that left me in tears. And the blood! There was so much blood. And clots the size of my palm. Despite wearing a super-plus tampon (yes, that’s a thing and I used to get them off Amazon in the US when they were still available) supported with the highest-absorbency menstrual underwear available, I would find myself having to change my tampon every hour. Yes, that means in meetings at work. In the middle of the night. On a long hike. In the middle of a phone call. It has drastically impacted my quality of life. 
For a long list of (stupid) reasons, I didn’t complain. But whenever my period app alerted me to the arrival of “red week”, it filled me with terror. Over time, my heavy periods had also become impossibly long, sometimes lasting 10 or 11 days. With a 24-day cycle, that meant I only ever had 2 weeks at a time when I wasn’t on my period. 
Fast forward to me feeling nauseous, tired and angry all the time, and I finally went to my GP. She checked my iron levels, which were 8 (the normal range is 80-100). She recommended that I get an iron infusion (I’d been taking supplements for years but they clearly didn’t work for me!) which I got, and referred me to a gynaecologist (a $350 fee, with $70 back from Medicare). 

Horrified at the c-word (cancer, not the other one), I signed on the dotted line.

Here’s where the plot thickens. I went to the gynaecologist, fully expecting (and dreading) an endometriosis diagnosis. Instead, I was told that I had two masses growing in my uterus — a large fibroid (which was causing the heavy bleeding) — and a very large polyp, which was just hanging out in my uterus, waiting to become cancerous if it wasn’t already. The gyno told me that I should come in the next week for surgery to remove it and have a biopsy on the polyp, and that it would cost (just her fees) ~$1200. Then there would be the anaesthetist fees on top (around the same as hers) and the hospital accommodation and theatre fees, another $2,490 — since it turns out that my “basic” health insurance covered very little of anything. Horrified at the c-word (cancer, not the other one), I signed on the dotted line. Medicare would pay me back $231 of her fees, and nothing else.
In addition to feeling worried, stressed and terrified, I was also livid. What were Medicare and private health insurance (that cost me $90 each month) good for? Clearly not much! After a whole lot of panicked Google searches and a second consult with my GP (who is amazing, by the way) I realised that I didn’t have to agree to the gynaecologist's proposed treatment. Here’s what I learned, and what I want you to know in case you ever find yourself in a similar situation. 

1. You can shop around

It feels weird, I know, especially because you can’t put a price on your health etc. But when I spoke to my GP and told her about my impending bill, she said that I actually have multiple options: I could go private/private (private specialist, private hospital), private/public (private specialist, public hospital, which in my case would save me around $4,000) or public/public (public specialist, public hospital). Obviously, not everyone will have access to all three options, but I was lucky I did. My surgery was also categorised at a level that meant that I didn’t need to wait too long in the public system. (In some cases, like a knee replacement, where the wait time is currently well over a year, the public system might not be an option, or a very painful one.) I ended up choosing the public/public system based on my risk profile, which cost me a grand total of $280 that I’d already spent on the private gynaecologist. 

2. You need to advocate for yourself

In the gyno’s office, once she had mentioned the word ‘cancer’, I was ready to hand her my life savings and my firstborn. She didn’t give me any choice — she implied (although obviously didn’t explicitly state) that she, and my impending $5,000 bill, were the only choice I had. That clearly wasn’t true.
After I’d gotten over the initial shock, I looked up the closest public hospitals to me and found a gynaecologist that met patients privately but performed surgery in the public hospital. I asked my GP about that option, as well as her thoughts on whether I did in fact need surgery in a week. Her assessment was that since the polyp had obviously been there for a while, it wouldn’t hurt to wait a bit longer for surgery. She ended up referring me to a public/public option in the non-profit cancer wing of a leading hospital, which would cost me nothing. 

3. If you have health insurance, don't bother with a basic policy

I wish I’d known this earlier, but according to Australian consumer watchdog Choice, “basic” policies are essentially junk, saying “they're so limited you’ll hardly ever be able to use them”. I found that out the hard way. A policy that cost only $25 more a month would've covered my hospital costs (minus an out-of-pocket $500 ‘excess’) and saved me at least $1,860. That still would’ve left me with the specialist and anaesthetist bills (which neither Medicare nor private health cover a significant portion of) but it would’ve helped.
As I await surgery in the public system, I recognise that I’m incredibly lucky to have options. I’m an Australian citizen and so I have access to Medicare, as well as the funds to be able to afford private treatment if I were desperate. But what if my surgery wasn’t a day procedure with a recovery time of 3 days? What if I had to spend weeks in a private hospital (at an unthinkable cost) or face an already burdened public health system? Hopefully, I’ll never have to find out. But as I wait for my surgery date, I have a renewed appreciation of how good we actually have it in Australia — if you know how to navigate the system. 
Author's name omitted for privacy.
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