Scopes
Endoscopies
What are endoscopies?
Endoscopies – also called scopes – are used to investigate certain medical and surgical conditions such as gastric ulcers, reflux and infections. When we refer to endoscopies and how we cover them, we only refer to four diagnostic endoscopies which include gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy. These are all used to investigate the digestive system. Scopes may also be used to investigate other body systems. All such endoscopies/scopes fall outside of this benefit.
Cover for gastroscopy, colonoscopy, sigmoidoscopy and proctoscopy.
Please call us to confirm your benefits at least 48 hours before having this procedure.
If the scope can only be done in a hospital setting we will pay for the hospital account and the related accounts up to 100% of the Fund Rate from the Hospital Benefit, subject to the overall annual limit.
If the scope could be performed in an out-of-hospital setting, but was done in-hospital, we will only pay for the related accounts up to 100% of the Fund Rate from the Hospital Benefit, subject to the overall annual limit. You will be liable for the hospital account from your own pocket.
Scopes for oncology patients will be funded from the Oncology benefit subject to oncology benefit rules.