Did you know that even if you are using private health insurance you can still be liable for thousands of dollars of out-of-pocket costs? Well, I didn’t. Did you know that public patients in a country like Australia may even enjoy the same treatments that private health insurance holders will receive, only they will receive it for free. Even though the public queue may be long, free is still free!

  • Having Private health insurance cover (in Australia) doesn’t mean that all things are covered, you may still be paying thousands of dollars for your surgery.
  • Depending on what country you are in, there will almost always be a cost for surgery that a privately insured patient will still have to bear. In the USA those costs will include ‘deductibles’ – the amount that you have to pay before you get the benefit of your insurance cover and, in a country like Australia, the medical gap cost – the difference between what your health fund will cover and what you doctor charges for a surgical procedure.
  • What doctors/surgeons/dentists can charge for an identical procedure can vary greatly. In Dallas, Texas, prices for a knee replacement vary from US$16,772 to US$61,584 while in Singapore the same procedure costs approximately US$10,000.
  • It may not be easy, but it is possible to find out upfront before booking surgery how much you’ll be out of pocket.
  • It can save you a lot of money if you’re prepared to negotiate with a doctor or shop around to get a better deal for surgery.
  • A more expensive doctor isn’t necessarily better than a more reasonably priced doctor.
The cost of being a private patient

It can be a massive surprise when you use your private health insurance policy for the first time and you get still get smacked with an enormous bill. I am pretty sure the reason that I’ve been paying for private health insurance was to avoid paying a giant bill. Well the truth is that there are all kinds of out of pocket costs that a patient may be responsible for, when they are in the most vulnerable state of illness. I am of the opinion that this isn’t the best combination. Ticadoc may finally be the place to find the information, solutions, data, and certifications that we have all been searching for.

Currently there are many costs private patients can get surprised with in hospital, while treatment for public patients in Australia is free.

These include:

  • out-of-pocket costs for consultations with your doctor in hospital­
  • procedures you aren’t covered for. Tip: Check with your insurer before the treatment
  • excess and co-payments
  • pathology costs, such as for blood tests
  • prostheses, such as an artificial hip. Tip: There’s always one suitable prosthesis that’s free
  • hospital incidentals, such as a TV or medication you take home (public patients can also be charged for these extra costs).

In the USA, if you are part of the 56% of the population that has private health insurance, then it is likely that your out of pocket expenses will have a cap or a maximum. Beware however that not only do your health insurance premiums increase each year, but the deductible amount and maximum out of pocket expense amounts will probably have risen even more sharply.

Out of pocket expenses and gaps aside, at least as a private patient the queue most likely won’t be as long as public patients may have to endure, making the experience a bit more comfortable. But, does that comfort and shorter queue add up to the cost of the fees? That may be the ultimate question – more so because the public hospital system will actually give priority to patients who have some life threatening conditions such as cancer. This decision can be quite complex not only from a mathematical perspective but also from an ethical perspective.

How do you feel about jumping the queue for a kidney or heart transplant when you are 70 and its between you and an eight year old? Whew, what a decision. With Private health cover you also have a choice of doctor, but how do you even make that choice? What are this doctors certifications? How long has this doctor been practicing? How many of these procedures has this doctor actually successfully completed? What sort of experience have the doctors previous patients had with the doctor? What does the facility look like? Is the facility clean, is it easily accessible and does it have best practice hygiene procedures in place? Wow! We really just have to trust that everyone is giving us the best advice, because until now there really hasn’t been an accessible over-arching body of information that is tailored to the questions that we may have.

Ticadoc is now the ever expanding global data base, where you will be able to find the latest International intelligence, options, and information with regard to your medi-traveler needs.


Even the thought of using a word like “Gap” makes you want to pull your hair out. Just tell us without using more Jargon please! I get enough jargon from the medical community, and now I have to hear it from my insurer. Please just make it easy!

Gap Defined: A gap is simply the difference between what Medicare and your private health fund will pay towards your treatment, and what your doctor or hospital charges. You’ll need to pay the difference (the gap), which is why it’s also sometimes called your out-of-pocket cost.

There are two types of gap schemes:

  • Hospital gap: for example, for accommodation costs
  • Medical gap: for example, for doctor and surgeon fees.
  • The Australian Government sets a fee for a range of treatments, procedures, tests and so on, and these are listed on the Medicare Benefits Schedule (MBS).
  • Medicare will pay 75% of the MBS fee for treatment of private patients in hospital.
  • Your insurer will pay the remaining 25%.
  • But doctors aren’t bound by the MBS so they often charge more than this fee, and the extra amount they charge is called the gap – or your out-of-pocket cost.
  • These costs can go into the thousands of dollars: it has been noted in a Choice survey that 25% of respondents who paid a gap said it was more than A$3000.

In the past it used to mean the we just had to figure out how to scrape our coins together, sell a watch, a car or even hock a prized possession. Now we have access to so much information via the internet that it can be incredibly over-whelming and trying to self diagnose even in the simplest situations isn’t the best feeling. At least now there is a bit of light at the end of this long dark twisting tunnel. There is a place to find targeted, certified information, reviews, evidence, choices and intelligence regarding the specific “medi-services” that you will or may currently be in need of to make more informed decisions.

Let us not let the “Gap” be the deal maker, deal breaker, life or dream taker any longer.

Be happy, be more informed and know more about Medi -Travel your options with Ticadoc.com.

Leave a Reply

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    Wow that was odd. I just wrote an incredibly long comment but after I clicked submit my comment didn’t appear. Grrrr… well I’m not writing all that over again. Anyway, just wanted to say great blog!

    1. Ticadoc Listing Owner

      Sorry about that! thanks for the shorter comment anyway!