Hysteroscopy out-of-pocket guide
Explore typical out-of-pocket costs experienced by GMHBA members for hysteroscopies performed in private hospitals. Understand potential costs and important questions to ask before treatment.
Hysteroscopy
If your hospital cover includes gynaecology and you’ve served applicable waiting periods, here’s a useful guide to the out-of-pocket costs reported in GMHBA Limited claims data for this procedure in a private hospital.
Out-of-pocket guide
Median out-of-pocket paid by GMHBA Limited members
What is a hospital excess?
This is the amount you pay upfront for a hospital admission before your health fund contributes. The excess on GMHBA hospital covers has an annual cap, meaning it’s only payable once per person (if applicable) per calendar year. Find out more about how the excess works.
You may be eligible to have your hospital excess waived^ for this procedure
- No overnight stay for your admission? GMHBA waives the hospital excess for same day procedures on select hospital covers.
- Most GMHBA Gold and Silver hospital covers waive the excess for child dependants aged under 21 when admitted to a private hospital.
^Check your fact sheet in the app or member area to see if you are eligible. All hospital waiting periods apply, including standard 2- and 12-month waiting periods.
What is a co-payment?
Applicable for Gold Optimum Hospital only (effective 1 January 2027), this is an amount you pay for each overnight hospital admission, capped at five nights per admission and charged in addition to the hospital excess. Unlike excess, there’s no annual cap on co-payments. Co-payments do not apply for same day procedures or for child dependants aged under 21. Find out more about co-payments.
How this guide works:
90% paid between $0 and $839 10% paid $839 or more
35626, 35630, 35633, 35635, 35636.
What is an MBS item?
MBS item numbers refer to a specific medical service or procedure and associated fees listed in the Australian Government's Medicare Benefits Schedule (MBS).
The primary procedure MBS item numbers are listed here but the out-of-pocket guide includes things like anaesthetist’s fees, assistant surgeon’s fees, radiology and pathology where applicable. These services will have their own MBS item numbers, not shown here.
*Based on hospital and medical claims data (1 January to 31 December 2025) for GMHBA Limited members undergoing this procedure as a private patient in a private hospital. Excludes fees and charges billed directly to the member. This is a guide only and is not a quote or guaranteed cost.
How can I reduce my hospital out-of-pocket costs?
Ask if your specialist participates in Access Gap Cover
This billing scheme, which providers must register for and opt into for your procedure, can help reduce or eliminate out‑of‑pocket medical costs for private inpatient treatment. Under the scheme, participating doctors are paid a higher amount by GMHBA in return for keeping medical gap fees to a minimum.
Based on GMHBA claims data (Jan-Dec 2025), around 80% of medical services are billed through Access Gap Cover.
What is the total cost for a hysteroscopy?
Total costs typically range from $2,102 - $3,961
If you’re covered for this procedure and admitted as a private patient, these costs will be covered by your health insurer and Medicare – less any hospital excess or co-payment that applies, and out-of-pocket costs.
Based on hospital and medical claims data (1 January to 31 December 2025) for GMHBA Limited members undergoing this procedure as a private patient in a private hospital. Excludes fees and charges billed directly to the member. This is a guide only and is not a quote or guaranteed cost. The range represents the middle 80% of admissions, meaning some procedures cost more and some less.
Who pays for what?
If you’re admitted to hospital as a private patient for this procedure, and it's included (not restricted or excluded) on your GMHBA cover:
Medicare will cover 75% of the MBS fee(s) for your private inpatient medical treatment. Medicare also provides rebates for some outpatient services (GP or specialist appointments, radiology and pathology), not included in this guide.
Medicare does not pay benefits for private patient hospital costs (accommodation and meals, theatre fees, or items from the Prescribed List). These are covered by your health insurer.
Where they apply, the patient will be responsible for covering the costs of any:
- Hospital excess and co-payment
- Medical gaps
- GP or specialist visits before or after your admission (outpatient services), less any Medicare rebate
- Private emergency department attendance fees
- Scans, blood tests and other pathology performed outside your hospital admission, less any Medicare rebate
- Personal incidentals such as TV hire, wi-fi or phone use
- Discharge pharmaceuticals (medications dispensed by the hospital to take home)
- Any gap for items utilised from the Australian Government’s Prescribed List.
What to expect when you have a hysteroscopy
A hysteroscopy is a planned procedure that uses a specialised medical instrument to look inside the uterus (womb). It’s used to remove growths, an intrauterine device (IUD) or to treat scar tissue and other conditions. When performed as an inpatient procedure, it may take place under general anaesthetic as a day procedure.
Hysteroscopies fall under the clinical category of gynaecology.
View your hospital fact sheet via the app or member area to see if this clinical category is included on your policy, and waiting periods that may apply.
Have an upcoming admission? Contact us to check your cover and find out more about how we can support your hospital journey.
Who can I contact for more information?
- About your cover
- Waiting periods
- Hospital excess and co-payments
- Participating private hospitals
- Specialists’ fees
- MBS item numbers
- Access Gap Cover
- Dates for procedure
- Hospital charges
- Excess payment arrangements
- Admission time
- What to expect on day of procedure
Find a provider or specialist near you
Use the search tool below to find medical specialists near you, see which hospitals they practise at, and an overview of the GMHBA member gap experience for their treatment. Looking for a private hospital? View our participating private hospitals.
FAQs
Hospital cover helps pay for your treatment, services and accommodation while you’re admitted to hospital as a private patient. It can give you more control over your care if you need to go to hospital – such as the choice to be treated in a public or private hospital, picking your doctor and potentially shorter wait times for elective surgery if you choose to be treated in a private hospital.
When you’re admitted to hospital as a private patient, your health insurer will pay benefits towards your hospital costs (accommodation, theatre fees, items like dressings and bandages) and both Medicare and your health insurer will pay benefits for medical costs (fees charged by the medical specialists involved in your treatment, including anaesthetists, and services such as radiology and pathology).
To be covered, you’ll need the clinical category for your treatment included on your cover and to have served relevant waiting periods before your admission.
Find out more about using your hospital cover.
Typical costs shown in this guide are based on historical claims data for GMHBA Limited members who have undergone this procedure as a private patient in a private hospital. We analyse claims paid during the reporting period and show a typical range of costs experienced by members.
This is a guide only and not a quote or guaranteed cost. Actual costs can vary depending on factors such as your specialist's fees, the hospital you attend, whether Access Gap Cover is used, your level of cover and any additional services required.
We recommend confirming all expected costs with your specialist, hospital and GMHBA before admission.
The guide reflects a range of costs experienced by GMHBA members in the past. Your quote is personalised to your treatment and may differ for several reasons, including:
- The fees charged by your specialist and other doctors involved in your care
- The hospital where your procedure takes place
- Whether Access Gap Cover applies
- Your level of cover and any applicable excess or co-payment
- Additional tests, services or treatments you may need.
For the most accurate information, ask your specialist for a written estimate of costs and contact GMHBA to check your cover and benefits before your admission.
A medical gap (or out-of-pocket cost) occurs if your doctor charges more than the Medicare Benefits Schedule (MBS) fee for your hospital treatment. This relates to the medical costs for your admission.
For inpatient specialist services, Medicare pays 75% of the MBS fee and your health insurer generally pays the remaining 25%.
If your doctor charges above the MBS fee and there is a medical gap, you may need to pay the difference.
Access Gap Cover can help reduce or eliminate these costs.
If your procedure is planned, there are steps you can take to minimise potential out-of-pocket costs:
- Check your cover early
- Explore your treatment options (private or public health system, seek a second opinion)
- Make sure your hospital is one of GMHBA’s participating private hospitals
- Ask your specialist(s) for a written estimate/quote of their fees and MBS item numbers, and whether they will use Access Gap Cover for your billing
- Contact GMHBA before going to hospital.
The Australian Health Service Alliance (AHSA) Access Gap Cover scheme is a billing system designed to reduce or eliminate the gap for inpatient medical fees.
Specialist doctors who are registered for, and choose to use, the Access Gap Cover scheme get a higher benefit from GMHBA (more than the standard 25% of the scheduled fee), in exchange for limiting the gap they charge to our members.
There are two scenarios for how GMHBA members may be billed when their specialist doctor uses the Access Gap Cover scheme:
- No gap – $0 to pay following the procedure
- Known gap – a maximum gap of $500 ($800 for obstetrics) to pay per doctor, per procedure.
If your doctor chooses not to participate in Access Gap Cover for the billing of your procedure, you’ll still be covered by Medicare and GMHBA for the scheduled fee, but will need to pay any gap.
Not always. If your specialist uses Access Gap Cover, you may have:
- No gap – no out-of-pocket cost for their inpatient medical services, or a
- Known gap – a capped out-of-pocket amount agreed under the scheme.
Other out-of-pocket costs, such as your hospital excess or co-payment (if applicable) or services not covered by your admission, may still apply.
Before your procedure, ask your specialist whether they will use Access Gap Cover for the billing of your treatment and request a written estimate of any costs you may need to pay.
Before your procedure, it's a good idea to ask your specialist for:
- A written estimate of their fees
- An outline of expected out-of-pocket costs
- The Medicare Benefits Schedule (MBS) item numbers for your treatment
- Whether they will use Access Gap Cover for the billing of your treatment
- Whether any other doctors will be involved in your care (such as an anaesthetist or assistant surgeon) and their likely fees
- Details of the hospital where the procedure will be performed.
Having this information can help you better understand your expected costs and allows GMHBA to provide more information about your cover and benefits before your admission.