Kidney stone treatment: what’s the best health cover?

Kidney stones are a painful condition that can affect 1 in 10 men and 1 in 35 women in Australia. While most stones will pass by themselves, some people will need to go to hospital for treatment and pain relief. In an emergency, you’ll be treated free in a public hospital but there can be long waiting lists for non-emergency kidney stone treatment. It’s faster to get treated in a private hospital, but there may be costs involved, even if you have health insurance.  

Kidney stone treatment is covered under the Kidney and Bladder clinical category, which is in all Bronze, Silver and Gold tier hospital policies in Australia. Here’s everything you need to know about kidney stone treatment on health insurance.   

What types of kidney stone treatment are covered? 

According to Better Health Channel, kidney stones happen when salts in urine form solid crystals that block the flow of urine, and if they don’t pass by themselves they can cause infection and kidney damage. While hospital treatment might be required, it often isn’t surgical. These days, less invasive treatments are preferred.   

Kidney stone treatments can include: 

• Extracorporeal shock-wave lithotripsy (ESWL) – where stones smaller than 2cm are broken up by ultrasound waves. Done under general anaesthetic, usually as a day procedure.  

• Percutaneous nephrolithotomy – a small cut is made in your back and stones larger than 2cm are removed. It’s done under general anaesthetic and usually results in a 2 to 4 day hospital stay.   

• Ureteroscopy or endoscope removal – sometimes called ureteropyeloscopy, a flexible telescope (ureteroscope is passed through the urethra into the kidney to break up stones using a laser. Depending on the method, it might be called renal pyeloscopy. This is done under general anaesthetic as a day procedure but may require an overnight stay. 

• Surgery – surgical removal of kidney stones is done when the other options won’t allow access to the stones. It’s an invasive procedure that requires a longer hospital stay.   

Can I use health insurance for kidney stone treatment? 

Kidney stone treatment is covered under the Kidney and Bladder category of Hospital Cover, which is included on all policies Bronze tier and higher. Sometimes it’s included on Basic Plus policies, but at a restricted level – which means you’d face substantial out-of-pocket costs.  

If you claim kidney stone treatment on private health insurance, Medicare will cover some of the treatment costs but you’ll have to pay an excess and co-payments (if they apply to your policy). You may also have to pay a Gap for surgeon fees (including your urologist, anaesthetists and any assistants). According to Medical Costs Finder, the average Gap for pyeloscopy (stone removal) is $430. 

Why do I have to pay a Gap with health insurance? 

How Gap cover schemes can save you money 

How do I find the best health insurance for kidney stone treatment?  

The fastest and most comprehensive way to search for a health insurance policy that meets your needs for kidney stone treatment (and more) is with the healthslips.com.au calculator. It’s free, checks every policy from every insurer in Australia, and you can see all results without entering your name, email or phone number. Use it to look for a new policy here or compare your existing policy with other policies available.   

healthslips.com.au does not provide general or personalised advice. Your particular circumstances are likely to impact the accuracy, completeness and relevance of the information or results. Take this into account before making a decision and talk to an expert for financial advice.     

Trudie McConnochie

Writer and Researcher

Knowledge is power – that’s the guiding principle behind everything Trudie writes, and it’s a philosophy she brings to her work at healthslips.com.au. By breaking down complex information into easy-to-understand blogs and stories, she aims to empower Australians to make the best choices and an informed decision around private health insurance.

Trudie understands firsthand some of the complexity of private health insurance having moved to Australia from New Zealand and having to navigate a vastly different public healthcare system and health insurance structure.

Trudie holds a Bachelor of Communication Studies (journalism major) from the Auckland University of Technology.

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