Can I get a colonoscopy using health insurance? 

If you need a colonoscopy in Australia, you could face a long wait. According to the Australian Institute of Health and Welfare, people waited between 133 and 197 days for a non-urgent colonoscopy in a public hospital in 2022 (between 4 and 6 months). For faster treatment, you might be wondering if you can go to a private hospital and claim on your health insurance. The answer is: yes, if you have the right cover. Here’s what you need to know about claiming a colonoscopy on your health insurance.  

What is a colonoscopy? 

A colonoscopy is a procedure done under sedation where a flexible tube with a tiny camera and light on it is inserted into your bowel. It’s performed so doctors can look for the cause of gut problems, remove polyps and take biopsies if necessary. It usually takes around 30 minutes so you won’t have to stay overnight.  

The waiting time for colonoscopies in Australia depends on the level of urgency.   

How much is a colonoscopy in Australia? 

Colonoscopies are covered by Medicare, which means they’re free in the public system, or you can go to a private hospital and claim on health insurance. Depending on your policy, you may have to pay an excess, co-payment and Gap (more on that below) for private hospital treatment. 

If you have Hospital Cover that includes the Gastrointestinal Endoscopy clinical category, you’re covered for colonoscopies – so long as you’re admitted to hospital, and not treated as an outpatient. Gastrointestinal Endoscopy is included in Bronze tier policies and above. Some insurers offer it on Basic and Basic Plus policies, but there may be restrictions on the level of cover provided, so check your policy carefully. 

What are the clinical categories covered by Hospital Cover?

We used the healthslips.com.au Calculator to calculate the cheapest Hospital Cover policy that includes Gastrointestinal Endoscopy cover for one adult with no children in Queensland. We found a Basic Plus policy with unrestricted cover and a $750 excess for $118.94 per month. Remember, there will be a waiting period for new policies, and if you’re upgrading your level of cover – especially if your colonoscopy is due to a pre-existing condition. Ask your insurer what waiting periods will apply to your policy.  

How long are waiting periods for pre-existing conditions?

Is there a Gap for a colonoscopy? 

There may be a Gap for a colonoscopy in a private hospital, or if you’re treated as a private patient in a public hospital. The Gap or out-of-pocket cost will depend on what your doctor charges and where you’re having the procedure. If your doctor charges more than the MBS Fee (Medicare Benefits Schedule Fee) – which is the amount Medicare and your private health insurer combined will pay – you will have to pay a Gap. According to Medical Costs Finder, around 26% of private patients who had a colonoscopy in 2023-24 had to pay a Gap, with the average Gap for a colonoscopy being $200. 

What is a Gap?

You can avoid paying a Gap by: 

• Choosing a doctor who charges a lower fee, or who has a ‘no Gap’ or ‘known Gap’ arrangement with your insurer. Get a detailed quote from your doctor and phone other gastroenterologists to find out how much they charge for the same service, and whether they have no Gap or known Gap arrangements with your insurer. If they don’t charge more than the MBS Fee, your Gap will be nil. 

• Having the procedure done in an Agreement Hospital, which means your insurer has a contract with that hospital to make sure you don’t have to pay a Hospital Gap. 

How can I lower my out-of-pocket costs?

Which health insurance is best for colonoscopy cover? 

The best health insurance for colonoscopy is the one that meets your healthcare needs and your budget. There are more than 48 insurers offering thousands of policies, so you’ve got a lot of options – and the healthslips.com.au Calculator allows you to search all of them in less than 30 seconds. Run a free comparison of your existing policy, or look for a new policy. You don’t have to enter your personal details, and there’s no commercial bias – which means you can trust the results.  

Try the healthslips.com.au Calculator.

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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