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Common questions

Breast cancer

This fact sheet is designed to help MBF members and their families be better prepared for the healthcare experience after a diagnosis of breast cancer.

Not all of the information here will be applicable to everyone, so it is important to discuss your individual circumstances with your doctor and perhaps with other healthcare professionals in the team caring for you. Please, never hesitate to ask 'why' or to have something explained to you until you understand it. If, after you have been given an answer, you still feel as though there are unanswered questions, ask again or ask someone else. You can help the healthcare team to help you if you feel free to communicate your needs to them. Further research and reading (see 'Learn more about breast cancer and its treatment') will also help you make more informed decisions about your treatment.

 Your treatment options

Around one in 11 Australian women develop breast cancer. However, every day there is more and more support, information and ongoing research available to help you or a family member through treatment and recovery.

Depending on your circumstances different treatments and combinations of treatment will be discussed with you.

The exact treatment for breast cancer will depend on several factors including:

  • tumor type (which is defined by the type of cell it comes from);
  • tumor size;
  • cancer stage (whether it has spread and by how much);
  • lymph node status;
  • your general health; and
  • how you feel about the different options available.

Treatment commonly includes a combination of some or all of the following:

  • diagnosis and breast biopsy
  • surgery
  • radiotherapy (radiation therapy)
  • chemotherapy
  • hormone therapy through medication or surgery; and in some cases
  • breast reconstruction

It is preferable that the specialist you choose be affiliated with a comprehensive breast cancer treatment program, one that can provide support and coordination of these different treatment options.

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 Questions to ask your doctor about your treatment

Every person and every case of breast cancer is different, so the treatment options will differ for every patient. Breast cancer is almost always treated by an oncology specialist who is highly experienced. A specialist who has extensive experience in treating cancer with very low complication rates and good outcomes is going to be the best person for the job.

Your GP will generally suggest one or more specialists and give you a referral.

To your GP/Referring Doctor:

  • What specialist would you recommend?
  • Why have you recommended this particular specialist?
  • Do you know what type of procedures I am likely to need?
  • Does this specialist have experience and expertise in this area?
  • Is this specialist associated with a comprehensive breast cancer service or comprehensive cancer centre?
  • Do you know anything about the radiotherapists and oncologists that may be involved if I go to this specialist?
  • Do you know if they charge a gap that Medicare or my health fund won't cover for my inpatient procedures? Or is there someone just as suitable that is more likely not to charge a 'gap' over the medical fee? Even so, choose your doctor first on the outcomes you can expect and their experience and expertise.

To the Specialist:

  • Will you explain the treatment I am going to have, starting in simple terms, please?
  • Why do you think this is the best treatment option for me? What are other options?
  • What are the likely outcomes of my treatment?
    • What are the chances that the outcomes will be good with this treatment or with the alternative options?
    • What are the possible complications and/or side effects associated with my surgery? How can I reduce the risks?
  • How many of the type of procedures I am likely to need have you done? How many do you do each year?
  • Are you associated with a comprehensive breast cancer service or comprehensive cancer centre?
  • Do you know anything about the outcomes for the radiotherapists and oncologists that may be involved?
  • If I need radiotherapy or drugs, where would I be going for that treatment? Are the outcomes of treatment at that centre better than those at other centres near here?
  • If I will need a breast prosthesis, where and when can I get one? What are the costs?
  • Do you charge a gap that Medicare or my health fund won't cover for inpatient services? Even so, choose your doctor first on the outcomes you can expect and their experience and expertise.
  • Does the anaesthetist who usually works with you charge a gap? If so, how much should I expect that to be?
  • How long do you expect me to be in hospital?
  • What is my expected recovery time?
  • What restrictions will I have regarding my everyday activities when I go home (ie. driving, lifting heavy objects)? If so, how long will I need assistance?
  • If I am to have chemotherapy, radiotherapy or hormone therapy, can you tell me how long the treatments will last? How will I expect to feel? What are the possible side effects and complications of these treatments? How can I reduce these?
  • Are there any clinical trials or new treatments I should know about?
  • What sort of monitoring and follow-up treatment should I expect once my initial treatment is over?

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 What MBF pays toward your treatment

Understanding how the healthcare system works can be confusing. This brief summary outlines what you can expect during breast cancer treatment. Always check with MBF before you go to hospital.

 Your hospital costs

All levels of MBF hospital cover help pay for inpatient treatments provided that:

  • you receive the services while you have been formally admitted in a hospital;
  • it is a treatment for which Medicare pays a benefit;
  • it is not an Excluded Service on your level of cover; and
  • you've met all the standard conditions of your membership (like serving the relevant waiting periods).

Selected MBF hospital cover will help pay for the following treatments and services so long as you are formally admitted to the hospital:

  • shared accommodation (or private room if available);
  • surgery related expenses including operating theatre, and intensive care if needed;
  • chemotherapy;
  • certain drugs supplied as part of your inpatient hospital treatment; and
  • certain therapies such as physiotherapy, occupational therapy and speech therapy when provided by the hospital and associated with your hospital treatment.

Please note that Medicare pays a Medicare benefit toward the cost of radiation therapy.

The costs of participating in clinical trials and experimental drugs are paid by the sponsor of the trial and are not covered by private health insurance or by the patient.

Remember, if you are not in an MBF Network Hospital and/or public hospital, you may incur substantial out-of-pocket expenses for your hospital charges.

Please note that surgeon's and other doctors' charges will be part of your medical costs.

 Your medical (doctors') costs

Ask your surgeon to explain the costs of your surgery including their own fees, and any fees that other doctors involved in the surgery might charge and any other expenses involved. If there are any gaps for you to pay, ask for a written cost estimate. This is known as 'informed financial consent'. Obtaining this information is extremely important before any planned hospital admission.

It is likely that there will be many doctors involved in your treatment and care. These may include the oncologist (cancer specialist), the surgeon, assistant surgeon, anaesthetist, pathologist, radiation oncologist (who oversees radiotherapy) and so on. You may not meet all of them in person.

Each doctor will charge for his or her services. See Going to hospital and Gap and informed financial consent for a guide to these costs.

Key things for you to know about medical costs and your health cover are:

  • MBF will pay benefits toward your doctors' charges for the service you receive:
    • when formally admitted as an in-patient in hospital or day surgery, and
    • when the service relates to treatment included under your level of cover, and
    • when you are entitled to a Medicare benefit for the treatment.
  • The Medicare Benefits Schedule Fee ('MBS') is the amount determined by the Commonwealth Government for the purpose of paying Medicare Benefits. For eligible in-patient services, Medicare pays for 75% of the MBS; MBF pays the remaining 25%.
  • Many doctors charge above the MBS, creating a 'gap' - an amount the patient has to pay.
  • MBF does not pay any amount charged by your doctor above the MBS unless there is an agreement in place between your doctor and MBF. This agreement is known as the MBF Medical Gap Cover Scheme.
  • MBF has created the MBF Medical Gap Cover Scheme to help reduce gaps paid by members. Doctors who participate in this scheme have agreed to accept the MBF benefit as full payment for your treatment. If a doctor has agreed to treat you under the MBF Medical Gap Cover Scheme there will be no 'gap' to pay for that doctor's charge.
  • It may be that not all doctors involved in your hospital treatment are 'no gap' doctors. So you may have to pay a gap for some doctors' services, but not others.

Remember, doctors are independent of MBF and can decide whether or not to treat you under the MBF Medical Gap Cover Scheme.

Click here for a list of 'no gap' doctors or call MBF.

 Your extras costs

Depending on your level of MBF extras cover, MBF can also help with the cost of a number of other healthcare services that may assist with the treatment and recovery from breast cancer.

These may include:

  • occupational therapy, to help you re-establish your usual living or working routine;
  • psychology, such as counselling for you and family members included on your cover;
  • prosthesis, single and bilateral mammary prosthesis following mastectomy;
  • physiotherapy, to help restore movement and function following surgery;
  • pharmacy, for drugs not listed on the Pharmaceutical Benefits Scheme; and
  • complementary therapies such as therapeutic massage.

MBF extras benefits are only payable for services provided in Australia by an MBF Recognised Provider. MBF Recognised Providers are health service providers that meet MBF guidelines. Call 131 137 to confirm whether or not your provider is a MBF Recognised Provider.

You can enjoy higher benefits on all preventive and general dental services and selected physiotherapy, optical, pharmacy and gym membership services (restrictions on claiming apply) by using the growing MBF MemberCare network of service providers. With our MBF MemberCare network of providers, you are guaranteed of receiving at least 70%-90% of the charge back on selected services depending on your level of cover, up to the annual limit of your cover. Find an MBF MemberCare service provider.

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 Learn more about breast cancer and its treatment

 

 More about going to hospital, MBF Network hospitals, no gap doctors and MBF MemberCare providers

As well as calling MBF, you can find plenty of useful information about your health cover and what to expect when you go to hospital right here on this website.

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Last updated: 05-06-07

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