This is asked constantly and answered badly, usually because the answer depends on which of three pathways you are on. What follows is the structure rather than a single figure, because a single figure would be misleading.
There is never one bill
A joint replacement generates at least four:
- The surgeon's fee. For the operation and the routine post-operative care that follows it.
- The surgical assistant. A separate practitioner who bills separately.
- The anaesthetist. Sets their own fee, which the surgeon does not control.
- The hospital. Accommodation, theatre and the implant itself. Usually billed to your health fund directly.
A quote covering only the surgeon's fee is not a quote. If that is all you have been given, ask for the rest.
Pathway one: private health insurance
If you hold appropriate cover for joint replacement, the fund contributes to the hospital costs, and Medicare plus the fund contribute to the medical fees. Your exposure is the excess on your policy plus any gap on the medical fees.
Many surgeons, including this practice, participate in no-gap arrangements with several funds. Where one applies, there is no out-of-pocket component on the surgeon's fee. Three things to check, because they catch people out:
- That your policy actually includes joint replacement. It is commonly restricted on lower tiers.
- That any waiting period has been served. Twelve months is standard for a pre-existing condition, and arthritis is almost always pre-existing.
- Whether the anaesthetist and assistant participate in the same arrangement. They bill separately and set their own fees.
Pathway two: self-funded in a private hospital
Possible, and quoted in full and in writing beforehand. You are paying the hospital and theatre costs and the implant as well as the medical fees, so the total is considerably higher than the gap a privately insured patient faces.
Some people take this route to avoid a public waiting list. It is a legitimate choice, and it should be made with the whole number in front of you rather than an estimate of the surgeon's fee alone.
Pathway three: the public system
Joint replacement is available through the Queensland public system at no cost, via a referral from your GP to a public orthopaedic clinic. The trade-offs are waiting time, which can be considerable, and that you do not choose your surgeon.
It is a reasonable pathway and it is worth saying so plainly on a private practice's website. If cost is the barrier, ask your GP about the public list rather than deferring treatment indefinitely.
Informed financial consent
This is the document that matters. Before anything is booked you should have, in writing: each of the four fees, the expected Medicare rebate, the expected health fund contribution, and the resulting out-of-pocket amount.
Nobody should discover what an operation costs after it has happened. If you have not been given this document, ask. If it is not forthcoming, that itself is information.
Two things worth asking your fund
Call your fund with the MBS item numbers from your estimate and ask them to confirm, in writing, the hospital cover, the surgeon's fee position and your excess. Funds answer these questions readily and it removes the last of the uncertainty.
See fees for how this practice handles it.
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.