Understanding costs

Frequently asked questions about cancer treatment costs

• What fees are included in the cost of my cancer treatment?

  Chemotherapy:

  Doctor’s fees – On the day of your treatment, you may have a consultation with your doctor. You will receive a doctor’s fee for this consultation, which will be charged directly to your health fund. Most doctors do not charge a gap fee, however others may charge more than the Medicare Benefits Schedule, meaning you will be required to pay a gap fee depending on your level of cover. We will let you know in advance if you have any out–of-pocket costs

  Medication fees – Chemotherapy medicines are expensive. However, the cost of most people’s treatment will be subsidised by the Pharmaceutical Benefits Scheme and your private health insurance. Most medicines that you take home with you after treatment (such as anti-nausea medication) will incur an additional fee

  Fees from other providers – As part of your treatment, you may receive services from other healthcare providers. This may include pathology services (such as blood tests and bone marrow biopsy) and radiology services (such as x-rays and scans). Our administration team can help you understand what other providers are involved in your care. For further information on these fees please contact the provider directly

  Consumable fees – Dressings and bandages provided upon discharge will be invoiced separately. Unfortunately, these items cannot be claimed for reimbursement either fund by Medicare or your private health insurer

  Radiation oncology:

  For radiation therapy, you will be charged for each treatment you have. The invoice for your first radiation therapy appointment may be higher than those through the course of your treatment as this will include the costs of initial simulation and planning that allow the radiation therapy treatment to be tailored to your specific needs.

• How much will my cancer treatment cost?

  In Australia, a wide range of health services are government-funded by Medicare (up to a certain benefit amount) regardless of whether you have private health insurance or not. Once the Medicare benefit has been reached, you need to pay the remaining amount of the treatment cost.

  For people with private health insurance, treatment costs are shared between your health fund and Medicare, but there are still some costs that will not be covered by either (such as a co-payment or gap fee).

  Your out-of-pocket costs may be influenced by:

  • The type of treatment and/or medications you receive

  • Your private health insurance policy level of cover

  • Government assistance through the Medicare Benefits Schedule, Medicare Safety Net, Pharmaceutical Benefits Scheme and Pharmaceutical Safety Net

  • Gap fee arrangements

  • Any additional expenses (such as travel, accommodation, and parking)

• I don’t have private health insurance - how much is my out-of-pocket fee?

  Chemotherapy and blood disorder treatments:

  If you do not have private health insurance, you will be required to self–fund your treatment. While you will need to pay for your treatment without the assistance from a private health insurer, you may still receive financial assistance through the Medicare Benefits Schedule (MBS), Medicare Pharmaceutical Benefits Scheme (PBS) or relevant safety nets.

  Rest assured, we will provide you with a detailed cost estimate and talk you through all the expected costs of your treatment. If you have financial concerns at any time, please don’t hesitate to discuss this with your administration team.

  Radiation oncology:

  Private health insurance is not required for radiation therapy, with up to 90% of the fee covered by Medicare. For radiation therapy, your out-of-pocket costs will be the gap fee and any additionally incurred costs (i.e., travel and accommodation).

• When am I required to pay for my cancer treatment?

  Payment is typically required on the day of each treatment. If you require any dressings, bandages or medications upon discharge, these may be invoiced separately. If you have financial concerns at any time, please discuss this with your administration team.

• If I have private health insurance, how will my claim for cancer treatment be processed?

  Icon has access to private health insurance with all health funds, and contracts with most major health funds. If we have a contract with your health fund, we can apply for your insurance pre-approval and process claims on your behalf. Your health fund will then send the payment directly to the centre to be credited to your account.

• How will my Medicare claim be processed for cancer treatment?

  Our centres have Medicare online claiming, which allows you to have Medicare benefits paid directly into your bank account.

• What do I need to bring to my appointment to ensure I’m billed correctly for cancer treatment?

  To ensure our team bill you correctly for your treatment, please bring the following along to your appointment.

  Chemotherapy and blood disorder treatments:

  • Medicare card

  • Any relevant healthcare cards – e.g concession, pension, DVA card

  • Private health insurance card

  • PBS Safety Net entitlement card

  • Prescription record form – these can be obtained from our on-site pharmacy or your local pharmacy and will help you keep track of your prescription tally for the Pharmaceutical Safety Net. You’ll need to have this form with you whenever you have a PBS medicine dispensed.

  Radiation oncology:

  • Medicare Card

  • Any relevant healthcare cards – e.g., concession, pension and DVA card

• Am I eligible to receive any financial assistance in paying for my cancer treatment?

  Everyone deserves the chance to access the best possible care, however we understand this can bring financial hardship. There are a number of cancer support organisations and charities that can assist with practical and financial assistance. Talk to your Icon care team about what might be available to you or visit the Cancer Council to understand what support is available in your area.

• What is the Medicare Safety Net?

  The Medicare Safety Net is a threshold designed to help those who have incurred high medical costs, providing you a higher Medicare benefit back for out-of-hospital costs. You can find out more and register as a single, couple or family here.

• Are there other Medicare benefits I might be eligible for?

  You may be eligible to receive Medicare benefits for allied health services (such a dietetics, physiotherapy or psychology) through a Chronic Disease Management Plan. To access this you will need a referral from your General Practitioner. Find out more here.

  If you don’t live near a major city, it can be harder and more expensive to access health services. The Patient Assisted Travel Scheme supports patients who require travel and accommodation to attend appointments and treatments. The program provides financial support or an escort to your treatment. Each State or Territory has their own scheme, with varying subsidies. Find out about the Patient Assisted Travel Scheme in your state or territory here.