In the Australian public health system, breast reconstruction applications are monitored by Medicare. It is up to Medicare to decide the final cost, if any, that the patients may have to pay out of their own pocket. For most public patients, surgery costs are funded entirely by Medicare unless the patient opts for an artificial breast prothesis.
When choosing a breast prothesis, the patient is responsible for purchasing the part.
Another feature of the publicly funded treatment is the wait list and times associated with the procedure.
In the private sector, Medicare still pays for up to 75% of the scheduled fee for the procedure, but as expected, costs of having an operation done privately are much higher than the scheduled fee alone. Privately done procedures do enjoy the benefit of being carried out as soon as possible without the patient being placed on a waiting list.
However, costs of privately funded reconstructive surgery can range vastly. According to a 2011 survey carried out by the Breast Cancer Network Australia or BCNA, patients had incurred anywhere between a minimum of $500 and less to a maximum of about $15,000 and above for the procedure.
Based on survey results, an overwhelming majority of 80% of the women who participated in the survey had had reconstructive surgery performed privately. Of those about 40% had paid services charges of about $5,000 and more with figures going up to $15,000 for some.
Out Of Pocket Costs For Breast Reconstruction
One part of the survey collected data from breast care nurses where the numbers reflected patients’ out-of-pocket spending averaging between $2,000 and $15,000 for the majority of women. Of these the highest percentage of patients paid between $5,000 and $8,000 for their operation.
Even with health insurance available, a number of patients have to cover gap fee as an out-of-pocket expense that can be an astronomical figure as well. Not all insurances will cover the entire expense involved in the reconstructive procedure.
Patients who are not with a private health fund are recommended to join one before the operation. However, it is important to remember that there may be a requirement to wait a qualifying period before any claims can be made for financial coverage.
In addition, different hospitals will have their own charges and costs involved. Financial rebate from the patient’s health fund will also vary and depend upon the type of coverage purchased as well as the fund itself.
The high price tag attached to the reconstructive surgery does not make it a suitable fit for everyone. In addition when patients may have to travel to other locations for their surgery, because their choice of breast reconstruction surgery is not available locally, the cost of travel and travel frequency also adds to the surmounting costs.
Discuss Financial Assistance Options Before Proceeding
Before opting for surgical breast reconstruction, all patients, private and public, should thoroughly discuss all available options with their healthcare practitioner, the hospital of their choice, their private health fund along with Medicare. Having more information on the financial aspects of the operation can help patients make a better choice; one that works for them and is monetarily realistic.
Patients may look into online fundraising to raise funds from family and friends in order to help cover the out of pocket costs for breast reconstruction.
1) Breast Cancer Network Australia Breast Care Nurse Breast Reconstruction Survey September 2011: http://www.bcna.org.au/sites/default/files/bcn_survey_report_20110922_0.pdf
2) Reconstruction: no right or wrong way: https://www.bcna.org.au/sites/default/files/69464_beacon_16pp_lores_0.pdf
3) Breast reconstruction: www.cancersa.org.au/information/a-z-index/breast-reconstruction#Financial_issues