Cost of Surgery for the Patient
Overview of private operation fees
This section aims to provide you with some basic financial information about the Private Health system. There is universal health cover in Australia from Medicare. This means that all Australian residents are covered by the public health system.
The private health system offers the advantage of choosing your surgeon, reduced waiting periods and access to a greater choice of surgery that may not be available in the public sector. The disadvantage is the financial costs associated with surgery. Most doctors’ costs are paid for by Medicare and health insurance companies supplement a little to this. In fact most of your health insurance goes into paying for your hospital stay and not the doctor’s costs.
There are several costs when seeing a specialist surgeon:
- Initial Consultation Fee – $200
- Review Consultation Fee – $100
- Cost of Surgery – guided by the AMA (Australian Medical Association) fee schedule (see below).
Cost of surgery
There are several costs to surgery. Most patients believe the bills they are paying are for the surgeons. In reality there are multiple providers who are sending out bills to the patients and the health insurance company:
- Surgeon’s Fees – Our Surgeons typically bill a proportion of the AMA Fee or a “Known Gap” Fee – this is normally around $500 out of pocket
- Assistants Fee(this is the doctor who assists the surgeon) – An assistant may charge a gap – typically no more than $100.
- Hospital bed and Theatre costs– If you have private health insurance this is confined to your excess, but certain orthopaedic procedures are excluded from your policy and therefore need to be checked prior to booking in surgery.
- Pathology and Radiology– These are blood tests and imaging taken during your inpatient stay that may also incur added costs.
- Implants and Prosthesis– Most of these are covered by your insurance company, but once again it is important to check with them prior to the surgery
Most orthopaedic consultations and procedures are covered by Medicare item numbers.