PAE cost & Medicare

Prostate artery embolisation is a Medicare-covered procedure in Australia. In practice that covers two separate things, and it helps to keep them apart.

The first is your consultation. A referral from your GP or another specialist is what allows a Medicare rebate to apply to it. You are still welcome to see us without one, but the rebate will not apply. The referral also lets us review your history and your imaging before you arrive, so the consultation can actually settle the question.

A consultation in our rooms at Macquarie carries a small out-of-pocket cost. One in the public clinic at St George does not. That difference is about where you are seen, not what cover you hold: privately insured patients are welcome in the public clinic, and patients without private cover are welcome in our rooms.

The second is the procedure. Where it happens changes who is involved: in a private hospital there is an admission alongside the medical side of the procedure, and your health fund covers that admission. In the public hospital you are treated as a public patient and the question does not arise.

Before you ring your fund. Prostate artery embolisation has its own item numbers, and they are not the numbers used for the operations it is usually compared with. Checking your cover against the wrong ones will give you an answer that has nothing to do with this procedure. Call our rooms and we will give you the correct numbers to quote.

We are a known gap provider. Where there is an out-of-pocket amount for the procedure, it is agreed with you and set out in a written estimate before anything is booked, rather than discovered afterwards.

That amount is our fee as the treating doctors, and it is the part we control. It is separate from what the private hospital charges for your admission, which is covered by your health fund and settled between you and them.

Surgery often requires anaesthetic support, which introduces an anaesthetist's fee. That is commonly not required for this procedure, which is done under local anaesthetic with light sedation.

We do not publish a figure on this page, because what applies to you depends on your cover, your policy tier and your excess. So bring your referral and your imaging, and we will go through your whole position with you before anything is booked.

And if that gap is the thing standing between you and treatment, tell us. We are happy to consider waiving it. We think these procedures should be accessible to the people who need them, and we would rather find a way through than have someone go without. Between the private and the public pathway, there is always a way to be treated.