Digestive System

What is covered under Digestive System?

Hospital Cover for Digestive System includes hospital treatment to investigate and treat the digestive system, including the:

• oesophagus
• stomach
• gall bladder
• pancreas, spleen
• liver
• bowel. 

Examples include:

• oesophageal cancer
• irritable bowel syndrome
• gall stones
• haemorrhoids.

This clinical category includes these treatments listed in the Medicare Benefits Schedule (MBS).

Examples include:

• clinical assessment of gastric-oesophageal reflux including monitoring equipment
• gastro-oesophageal balloon intubation, for control of gastric-oesophageal bleeding 
• treatment for laparotomy or laparoscopy for generalised intra-peritoneal sepsis (infection).

Some treatments you might expect to be in the Digestive System clinical category are in other clinical categories. For example, treatments for:

• exploring your gastric tract with a device is under Gastrointestinal Endoscopy
• hernia and removal of appendix are under Hernia and Appendix
• surgery to help you lose weight is under Weight Loss Surgery
• chemotherapy and radiotherapy for cancer is under Chemotherapy, Radiotherapy and Immunotherapy for cancer.

Which Hospital Cover tiers include Digestive System?

What does it mean if cover is ‘optional’?

‘Optional’ means that the Australian Government allows insurers to choose whether or not to cover the clinical category under that Hospital Cover tier.

What does ‘restricted cover’ mean? 

Restricted cover means the insurer pays only limited benefits. 

If insurers offer cover for Digestive System under Basic Hospital Cover, they can do so on a ‘restricted’ basis. If you are admitted as a private patient in a private hospital for treatments under this clinical category, you will face considerable out-of-pocket costs.

Always check with your insurer before agreeing to be treated as a private patient in a private hospital if you have restricted cover for Digestive System. 

Does Medicare cover Digestive System?

Yes. Medicare includes all treatments under the Digestive System clinical category.

If there is an MBS item number for the treatment, Medicare covers it. 

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