6 months on from my surgery I thought I would document my financial journey in the Australian health system.
There is a lot written here about USA and to a lesser extent UK and Europe, but our health system is so different.
Firstly a review of how the system fits together.
1. GP – General Practitioner -first line of treatment. Cost covered by Medicare (funded by federal government) and/or co-payment. If the GP chooses to bulk bill there is no out of pocket cost. If they charge more than the schedule fee you pay the full cost and get a rebate from Medicare for the schedule fee.
2. Specialist – Urologist, Anaesthetist – for in office consultation billing works the same as for the GP. They might forward your claim to Medicare for you, or you may have to lodge a claim directly. You must have a referral from your GP to be eligible for Medicare rebate from a specialist.
There is schedule fee for the surgery which is covered in part by Medicare. If you have private health cover they will also pay part. If the surgeon charges more than the schedule fee that is called the “gap” and is payable by the patient.
3. Public Hospital – in the case of an emergency you will be treated for free. (funded by state government). Just when you think it’s all free you get the bill for the ambulance. For non-emergency, non-life threatening cases you will be triaged with all other patients in that department and put on a waiting list, possibly years. No choice of surgeon.
4. Private Hospital – Your chosen surgeon will make a booking at his preferred hospital. Hospital costs are either billed directly to you or to your health insurer. Many hospitals use DRG (Diagnosis-Related Group) charging as an averaging method across patients to simplify accounting. There may be an excess or co-payment depending on your policy.
5. Prosthesis – There is a schedule fee for the implant which your health insurance will pay 100%
Download All Prescribed List Items from
https://www.health.gov.au/resources/pub ... anguage=en and look at lines1348-1374
Who pays?
1. Medicare - is a federally funded health insurance. They will cover part of your expenses for both out of hospital services and in hospital services. All Australian citizens and permanent residents are entitled to receive either free treatment (in some cases) or a Medicare rebate for part of the bill for treatment.
2. Private Health Insurance – Hospital cover and/or Extras cover. Extras cover is treatment specific such as dental or physio. Hospital cover can only cover in hospital treatment, the hospital stay, surgery and prosthesis.
Hospital cover generally has a waiting period for pre-existing conditions. A prosthesis for ED will always be a pre-existing condition. Normal waiting time is 12 months. If you are reading this and don’t have hospital cover take it out NOW. The journey from considering an implant to actual surgery is a long one and the value of private hospital cover cannot be underestimated.
There is no specific inclusion or exclusion on my policy. I am covered for “Male reproductive system”.
Private health cover may also include ambulance cover, either in Extras and/or Hospital cover.
Most hospital cover will have an excess, payable on the first claim of the year and may have a co-payment per night in hospital.
3. Ambulance cover – available from your state ambulance service.
4. PBS (Pharmaceutical Benefits Scheme) – Federally funded subsidised pharmaceuticals. The cost of many common medications are capped at a maximum of $25.00 for general patients and $7.70 for concession card holders.
Your pain killers may or may not be covered (mine weren’t).
NO ED medications (Cialis, Viagara etc. are covered)
So, how does that look in the real world? Here are my real costs in late 2025, early 2026. As previously noted, the way you are charged and reimbursed is variable depending on the GP, specialist and hospital.
There was a long journey of ED and prostate issues leading up to the decision to investigate an implant. This list starts at the investigation stage and does not include incidentals such as travel or out of hospital medications.
1. GP long consultation
Medicare $82.90 Out of Pocket $57.20 Total $140.10
2. Initial consult Surgeon 1
Medicare $84.15 Out of Pocket $275.85 Total $360.00
3. Initial consult Surgeon 2 (2nd opinion and final choice)
Medicare $84.15 Out of Pocket $195.85 Total $280.00
4. Pre surgery consult Anaesthetist
Medicare $125.95 Out of Pocket $174.05 Total $300.00
5. Hospital costs. DRG Penis Procedure.
Health Insurance $2737 Out of pocket Excess $500 Co-payment $100 Total $3337
6. Artificial erection device, insertion of
Medicare $ 852.70 Health Insurance $607.10 Total $1459.80
7. Insertion of pump
Medicare $141.40 Health Insurance $100.65 Total $242.05
8. Surgical assistant
Medicare $ 198.85 Health Insurance $ 187.93 Total $ 386.78
9. Surgeon Gap Fee
Out of Pocket $500.00 Total $500.00
10. Initiation of the management of anaesthesia
Medicare $ 69.30 Health Insurance $ 85.10 Total $ 263.45
11. Anaesthetist 1:31 HOURS to 1:45 HOURS
Medicare $121.30 Health Insurance $ 339.85 Total $ 461.15
12. Anaesthetist Gap Fee
Out of Pocket $350.00 Total $350.00
13. AMS 700 Series Inflatable
Health Insurance $8070.00 Total $ 8070.00
14. AMS 700 Series Reservoir
Health Insurance $1881.00 Total $ 1881.00
15. 3 months check up
No Charge
16. 6 months check up
Medicare $43.35 Out of Pocket $103.30 Total $146.65
Total Costs:
Medicare $1,801.05
Health Insurance $14,008.63
Out of Pocket $2,256.25
GRAND TOTAL $18,065.93
Your experience may be different
ED since my 40s, managed by pills.
Increasingly severe BPH, emergency HoLEP prostatectomy Nov 2021.
Fixed the prostate but pills slowly became less and less effective.
AMS 700 CX 20th Jan 2026
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