You get the numbers in writing, before you decide.
Nobody should find out what an operation costs after it has happened. Every patient in this practice receives a written estimate covering the surgeon's fee, the surgical assistant, the anaesthetist and the hospital, together with the expected Medicare and health fund contributions and the out-of-pocket amount, before anything is booked.
That document is called informed financial consent. It is a professional obligation rather than a courtesy, and you should not proceed to surgery without one. If you have been quoted a single number over the phone by any practice, that is not informed financial consent, because a single number cannot cover four separate billers.
A joint replacement generates four bills.
This is the part that surprises people, and it is the reason quotes are hard to compare.
- The surgeon's fee. Professor Rodda's fee for the operation and the routine post-operative care that follows it, including your reviews at two and six weeks, three months and twelve months.
- The surgical assistant. A second surgeon assisting in theatre. Billed separately, by them.
- The anaesthetist. Set by the anaesthetist, not by this practice, and billed separately. This is the bill patients most often do not know is coming.
- The hospital. Accommodation, theatre time and the implant itself. Usually billed directly to your health fund, with your excess payable by you on admission.
A quote covering only the first of those four is not a quote for a joint replacement.
If you have private health insurance.
With appropriate cover for joint replacement, your fund contributes to the hospital costs and, alongside Medicare, to the medical fees. Professor Rodda participates in no-gap arrangements with several funds, which means the practitioner fees are covered in full where you hold eligible cover and have served any waiting periods.
Two things to check with your fund yourself, before your surgery date, because only they can confirm them:
- Your level of cover. Joint replacement sits in a restricted category on many policies. Confirm that yours includes it.
- Your excess. Set by your policy, payable to the hospital on admission, and not covered by any no-gap arrangement.
Waiting periods also apply on new policies and after upgrades, and they are typically twelve months for a pre-existing condition. If you are considering taking out or upgrading cover for this, do it early.
If you do not have private cover.
There are two routes and neither is hidden from you.
The public system. Joint replacement is available publicly through your GP. Waiting times vary considerably. The rooms will tell you plainly if that is the more sensible route for your circumstances rather than steering you towards private surgery.
Self-funded private surgery. Possible, and quoted in full in advance. It is a substantial sum, because without a fund you are paying the hospital, the theatre and the implant as well as the practitioners.
WorkCover, CTP and DVA.
If your problem is covered by a workers' compensation claim, a compulsory third party insurer or the Department of Veterans' Affairs, the process is different and the rooms handle the approvals. Nothing proceeds until the insurer approves it in writing, and in an accepted claim you should not receive a bill. See WorkCover and CTP.
Consultations and referrals.
Consultations attract a fee with a Medicare rebate, provided you hold a current referral. A GP referral lasts twelve months from the date of the first consultation; a specialist referral lasts three. If your referral has expired you can still be seen, but the rebate may not apply, so it is worth checking the date before you attend.
Telehealth consultations attract the same rebate arrangements as in-person consultations where the criteria are met, which matters for patients travelling from Gympie, the Wide Bay and further.
The physiotherapy review fee.
One cost sits outside the four bills above and outside any no-gap arrangement, so it is set out here rather than buried. Every joint replacement patient has two half-hour physiotherapy reviews, at week two and week twelve, and those two appointments cost $280 in total. It is the same figure for everyone. Patients travelling from interstate attend a single review at week twelve instead, and pay $140.
This is a physiotherapy charge, not a surgical one. It is not part of the no-gap arrangement, because no-gap covers the surgeon, the assistant and the anaesthetist, and a physiotherapy appointment is a separate service by a separate practitioner. The rooms take the payment and Fortius Allied Health issues the receipt. If you hold extras cover, you claim your rebate back from your fund online yourself after the appointment, in the same way you would for any physiotherapy visit.
The two reviews are part of the pathway rather than an optional extra. Week two is where a wound problem or a stiff knee gets caught early, and week twelve is where your progress is measured against where it should be. What that recovery looks like week by week is set out in what is normal after joint replacement.
What to ask, here or anywhere.
Four questions, and they are as reasonable to ask this practice as any other.
- What is the total out-of-pocket cost across all four bills?
- Can I have that in writing before I commit?
- Is my fund one you have a no-gap arrangement with, and does my level of cover qualify?
- What is not included, and what might be added later?
If a practice cannot answer those four in writing, that is information. The full argument is in what does a knee replacement cost in Australia.
Common questions.
Are there any costs not covered by the no-gap arrangement?
Yes, one. Every joint replacement patient has two half-hour physiotherapy reviews, at week two and week twelve, and those cost $280 in total. Patients travelling from interstate attend a single review at week twelve and pay $140. It sits outside the no-gap arrangement because no-gap covers the surgeon, the surgical assistant and the anaesthetist, and physiotherapy is a separate service. The rooms take the payment and Fortius Allied Health issues the receipt. If you hold extras cover you claim the rebate back from your fund yourself after the appointment. Your hospital excess is also payable separately, and is set by your policy rather than by this practice.
Who bills the $280 physiotherapy fee?
The rooms take the payment and Fortius Allied Health issues the receipt. If you hold extras cover with your health fund, you claim the rebate back online yourself after the appointment, the same as for any physiotherapy visit.
What is a gap payment?
A gap is the difference between what a doctor charges and what Medicare and your health fund pay back between them. If the fee is higher than the combined benefit, the remainder is the gap and you pay it. Gaps vary between doctors and between funds, and they are not fixed by any schedule.
What is a no-gap arrangement?
An agreement between practitioners and a health fund to accept the fund's benefit as payment in full. Under the arrangements Professor Rodda participates in this covers the surgeon's fee, the anaesthetist's fee and the surgical assistant's fee. If you hold eligible cover with a participating fund and have served any waiting periods, there is no gap to pay on those fees. Your hospital excess is separate and still applies.
Is the implant different under a no-gap arrangement?
No. The implant is chosen for your anatomy, your age and the technique planned for you, against Australian registry data. A no-gap arrangement determines how practitioner fees are paid. It has no bearing on which implant is used or on how your surgery is performed.
Will I have any out-of-pocket costs at all?
Your hospital excess is set by your policy and is payable to the hospital on admission. It is not covered by any no-gap arrangement. Depending on your care there may also be costs for imaging, physiotherapy and medications. Confirm your excess with your fund before your surgery date.
Why do different surgeons quote different amounts for the same operation?
Because there is no set fee. Medicare publishes a schedule fee, health funds set their own benefits, and surgeons set their own fees, and the three numbers rarely match. That is why the only figure worth comparing is the total out-of-pocket amount across all four bills, in writing.
What if I do not have private health insurance?
Joint replacement is available in the public system through your GP, and the rooms will tell you plainly if that is the more sensible route for you. Self-funded surgery in a private hospital is possible and the total is quoted in advance; it is a substantial sum because it includes the hospital, the theatre and the implant rather than only the surgeon.
Is the consultation covered by Medicare?
Consultations attract a rebate provided you hold a current referral. A GP referral lasts twelve months from the first consultation and a specialist referral lasts three. If your referral has expired you can still be seen, but the rebate may not apply, so check the date before you attend.
What if my surgery is covered by WorkCover, CTP or DVA?
The process is different and the rooms handle the approvals with the insurer. See WorkCover and CTP. Nothing proceeds until the insurer has approved it in writing, and you should not receive a bill.
This page provides general information about a medical condition and a surgical procedure. It is not individual medical advice and does not replace consultation with a qualified practitioner. Outcomes vary between individuals and all surgery carries risk. A referral is needed for a consultation with Professor Daevyd Rodda; without one, you can start with the practice nurse practitioner, who can provide it.