No-gap joint replacement cover.

No. A no-gap arrangement affects billing only. It has no bearing on the implant used, on how long you stay in hospital, or on any part of your treatment. You receive the implant Professor Rodda would choose for you either way, and you go home when your recovery allows it, not when a billing arrangement says so.

It depends on both. You need to be with one of the four participating funds, and your level of hospital cover has to include joint replacement with any waiting period served. Two people with the same fund can get different answers. Call the rooms and we will help you confirm it with your fund before you are booked.

Medibank covers all joint replacements. Bupa and HCF cover hip and knee replacement. nib covers hip, knee, and complex hip and knee replacement. These are the arrangements as they stand with this practice; your fund can confirm how they apply to your policy.

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. Rehabilitation, imaging and medications are billed separately by whoever provides them. You receive a written estimate of your surgical costs before you are booked.

A gap is the difference between what a doctor charges and what your health fund and Medicare pay back between them. If the fee is higher than the combined benefit, the remainder is the gap and you pay it out of your own pocket. Gaps vary between doctors and between funds, and they are not fixed by any schedule.

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 relevant waiting periods, there is no gap to pay on those fees. Your hospital excess is separate and still applies.

No. The implant used in your joint replacement is chosen by Professor Rodda based on your anatomy, your age and the surgical technique planned for you. 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. Every patient receives the same standard of care regardless of their health fund.

Your hospital excess is set by your policy and payable to the hospital on admission, and it is not covered by any no-gap arrangement. Depending on your care there may also be costs for rehabilitation, imaging or medications, billed by whoever provides them. You receive a written estimate of your surgical costs before your surgery date.

Your excess is a fixed amount set by your policy, usually payable once per year or per admission depending on your cover. It is charged by the hospital, not by the practice, and it is not affected by a no-gap arrangement. Your fund can tell you the exact amount and whether you have already paid it this year.

You can still have your surgery with Professor Rodda. Without a no-gap arrangement your fund will pay a benefit toward the fees and there may be an amount left over for you to pay. You receive a written estimate of any out-of-pocket cost well before your surgery date, so there are no surprises.

You are free to change funds at any time. Under Australian portability rules, waiting periods you have already served on equivalent cover generally carry across to your new fund, but if you move to a higher level of cover a new waiting period may apply to the upgraded portion. Timing matters if you are already planning surgery, so speak to both your current and your prospective fund before making a change. The Private Health Insurance Ombudsman's site, privatehealth.gov.au, is an independent source for comparing policies. This practice cannot advise you on which fund to choose.

Your stay is determined by your recovery. You remain in hospital for as long as is clinically required for you to go home safely. If you need inpatient rehabilitation before going home, that is arranged as part of your recovery pathway and covered under the same arrangements.

Yes. Health funds apply waiting periods for joint replacement, and these must be served before your fund will pay benefits, including under a no-gap arrangement. Waiting periods are commonly twelve months for a pre-existing condition, and arthritis you already have counts as pre-existing. The exact terms depend on your policy and your fund can confirm your status in a single phone call.

The practice manager can talk you through your written estimate. For questions about your level of cover, your excess or your waiting periods, your health fund is the best source because they hold your policy details. For hospital charges, contact the hospital directly.