Gastroscopy cost
Expert tips for gastroscopy cost
Our health insurance expert, Steven Spicer, has some tips on choosing the right health insurance to help with your gastroscopy costs.
Steven Spicer
Executive General Manager – Health, Life & Energy
Make sure you’re getting the right level of cover
When comparing policies, choosing the right level of cover is one of the most important decisions you’ll make. You want to be covered for the services that are important to you without paying for a higher level of cover than you require. Consider your health and lifestyle and find a policy that best meets these needs.
Lower premiums aren’t always the answer
We all love a bargain, but simply going for the policy with the cheapest premiums could backfire and leave you underinsured. You can increase your excess to lower costs instead of giving up inclusions to save money.
Compare your options
It’s always worth doing research and shopping around for the right health insurance. Prices will vary from fund to fund, with plenty of different options to choose from. If it all seems like a lot, remember you don’t need to go it alone; our experts are here to help!
Keep your waiting periods in mind
When joining hospital cover for the first time, or upgrading your policy, you will be required to serve any relevant waiting periods before making a claim. It’s therefore a good idea to take out cover before you think you will need it, to allow time to serve your waiting periods.
What is a gastroscopy?
A gastroscopy (sometimes called upper endoscopy or a gastrointestinal endoscopy) is an examination procedure that looks inside your oesophagus, stomach or small intestine (the first part of your small bowel).1 The procedure involves a gastroscope (a thin, flexible tube with a camera on the end) being put in your mouth and moved down into your stomach. Usually, a gastroscopy is a day procedure and only takes between 15-30 minutes. The procedure is performed by a gastroenterology specialist, also known as a gastroenterologist.
If necessary, your specialist can perform other procedures during your examination, such as:1,2
- Taking a biopsy (a small tissue sample)
- Stopping an ulcer bleeding
- Removing polyps (small growths).
Why would I need a gastroscopy?
There are a few key symptoms your doctor may want to investigate further through a gastroscopy, including:1
- Nausea
- Indigestion
- Vomiting
- Abdominal pain
- Difficulty when swallowing.
A gastroscopy can potentially reveal inflammation, bleeding, ulcers or growths, and is also used to help diagnose conditions such as coeliac disease.1 It can be used to widen a narrowed oesophagus or to remove a swallowed object.
How much does a gastroscopy cost?
When performed in a private hospital, specialist fees for a gastroscopy (Medicare Benefits Schedule item #30478 and #30473) will typically be around $970, which includes your specialist, assistant surgeon, and anaesthetist fees.3 Of this total cost, Medicare paid $430 and a health fund typically paid $370. These prices are current as of September 2024.
Hospital fees for the procedure typically add another $550 to your costs. Your health fund will usually help cover these fees; however, there may be out-of-pocket costs or gap fees, depending on where and who you are treated by. Some hospitals and doctors may have a no-gap arrangement with your health fund.
Remember, many factors can influence your surgery costs, including which healthcare facility you visit, where in Australia you live, how much your treating doctors charge and how complicated your procedure may be. Colonoscopies are sometimes performed on the same day as a gastroscopy if your doctor thinks it’s necessary. If this is the case for you, you’ll need to factor this into your costs.
Does Medicare cover gastroscopy?
If you choose to have your gastroscopy performed at a public hospital, there won’t be any fees for the procedure itself. While this sounds great, there are some downsides to keep in mind. As a public patient, you’ll often be subjected to lengthy waiting lists for public hospitals. You’ll also have little to no flexibility when it comes to who performs your surgery and when.
Does private health insurance cover gastroscopy?
Gastroscopy is an in-patient procedure, so it will be part of your hospital cover. The good news is Bronze tier hospital insurance includes gastrointestinal endoscopy as does every higher level of cover.
Being treated as a private patient comes with numerous benefits. These include avoiding the long public waiting lists and having more flexibility regarding where and when your procedure will be performed.
Are there waiting periods for claiming gastroscopies through private cover?
Before claiming a gastroscopy treatment, you’ll need to serve a minimum two-month waiting period. If you have any symptoms or signs that would require a gastroscopy within six months of starting your policy, you may need to serve a longer waiting period. For pre-existing conditions, the waiting period will be 12 months.
If you’re switching to a new health fund but staying at the same level of cover, you won’t need to re-serve any previously served waiting periods. If you’re upgrading your policy or haven’t finished a previous waiting period, you’ll might need to continue from wherever you were.
Meet our health insurance expert, Steven Spicer
As the Executive General Manager of Health, Life and Energy, Steven Spicer is a strong believer in the benefits of private cover and knows just how valuable the peace of mind that comes with cover can be. He is passionate about demystifying the health insurance industry and advocates for the benefits of comparison when it comes to saving money on your premiums.
Want to learn more about health insurance?
1 Health direct – Gastroscopy. Accessed September 2024.
2 Healthy WA – Gastroscopy (endoscopy). Accessed September 2024.
3 Medical Cost Finder – Gastroscopy. Accessed September 2024.