Tamara was grappling with a cancer diagnosis. Then came the $35,000 in medical bills

Tamara Macpherson was already grappling with a breast cancer diagnosis when she was dealt another devastating blow, in the form of a $35,000 medical bill.

The Melbourne mother of two had paid for top-tier private health insurance for years before she was diagnosed with cancer in 2024.

Out-of-pocket costs and specialist fees for some of the most common types of surgery have been soaring, according to new data collated by Private Healthcare Australia, the peak body for health funds.

The analysis, which examined fee costs between 2018-19 and 2024-25, revealed that while some privately insured patients were paying nothing in gap fees, others were being left to fork out thousands of dollars, and a growing number have been charged far above the median cost of their procedure.

For Macpherson, the first shock was the thousands of dollars in out-of-pocket expenses she was hit with during the diagnostic phase, which is largely covered by Medicare, not private health insurance.

Then came the medical bills for four operations, including a mastectomy and reconstructive surgery. For this complex nine-hour surgery alone, Medicare paid $7000 and Macpherson’s private health fund paid $2000. She was left footing the bill for another $22,000.

“I support specialists getting paid in alignment with their training and skill ... They are highly, highly trained and skilled,” the 55-year-old said. “But I was left completely shocked at how big the gap was.”

Looking at other types of surgery, the data showed that for knee replacements, 90 per cent of patients were paying out-of-pocket fees to their surgeon, gap fees having doubled in the past six years from $560 to $1080. One in 10 Australians who had a knee replacement were being hit with fees of more than $5300.

For a hip replacement, the median out-of-pocket fee was $1240, and 10 per cent of patients were charged more than $5500.

Two-thirds of privately insured patients were paying out-of-pocket fees for cataract surgery, up from fewer than half six years ago. The median cost was about $500, but about 10 per cent of patients were being stung $1800 in fees.

Specialist fees were also on the rise for routine procedures including children’s tonsil removal. While a typical gap fee is $850, some specialists have been charging more than $2200. Fees for prostate surgery and biopsies were also rising sharply, with some men paying thousands of dollars in gap fees.

Private Healthcare Australia chief executive Dr Rachel David said many people did not realise fees could vary so dramatically for the same procedure, and often felt l