01
The hospital
Theatre time, the ward or intensive care bed, nursing, and any implants used. If you are privately insured this is usually the account your health fund covers most of, subject to your excess and your level of cover.
What it costs, and how to find out
Cost is one of the two things that most often stops people getting a specialist opinion at all. This page explains how private surgery is billed in Australia, what this practice publishes about its own fees, and the specific questions to ask so you know your out-of-pocket amount before you commit to anything.
The short version
Private surgery in Australia generates several separate accounts, not one bill. That is the single most common surprise.
Medicare rebates are available with a valid Medicare card and a current referral.
The practice states that a private fee is generally charged for surgery.
Under some circumstances treatment can be provided through a medical gap scheme.
Self-insured estimates are given for patients without private health insurance, and payment plans are available.
No website can quote your figure. Ask the rooms for it in writing, and ask the anaesthetist and hospital for theirs.
4 accounts
Hospital, surgeon, anaesthetist and often a surgical assistant. Each bills separately.
Referral
Medicare rebates are available with a valid Medicare card and a current referral.
Gap scheme
Under some circumstances treatment can be provided through a medical gap scheme.
Uninsured
Self-insured estimates are given for patients without private health insurance, and payment plans are available.
HOW IT IS BILLED
Private surgery is not one bill
This is where most of the confusion comes from. Several independent providers are involved in one operation, and each of them bills you separately. Getting a figure from one of them is not the same as knowing what the operation costs.
02
The surgeon
The operation itself and the surgical care around it. Medicare pays a scheduled amount, your health fund may pay a further amount, and any difference is the out-of-pocket cost.
03
The anaesthetist
A separate specialist with a separate account, which the practice does not set. Ask for their estimate as well, because it is a common source of an unexpected gap.
04
The surgical assistant
Many spinal operations involve an assistant, who also bills separately. Smaller than the others, and still worth having in the total before you agree to a date.
Add to that any imaging, pathology or physiotherapy arranged around the operation. The useful question is not what the surgeon charges, but what your total out-of-pocket amount will be across all of them.
WHAT THE PRACTICE PUBLISHES
The practice's stated position on fees
These are the arrangements the practice publishes. Your own figures come from the rooms rather than from this page.
01
A private fee for surgery
The practice states that a private fee is generally charged for surgery. What that means for you depends on the procedure, your cover and your circumstances.
02
Medical gap scheme
Under some circumstances, treatment can be provided through a medical gap scheme. Gap schemes are arrangements between health funds and doctors that reduce or remove the out-of-pocket amount.
03
Estimates if you are uninsured
Self-insured estimates are given for patients who do not have private health insurance, so that the figure is known in advance rather than discovered afterwards.
04
Payment plans
Payment plans are available. If cost is the obstacle rather than the decision itself, that is worth raising directly with the rooms rather than quietly not proceeding.
The practice also sees privately insured, uninsured, WorkCover, DVA, Defence, interstate, overseas and medico-legal patients, and the billing arrangements differ between them. Contact the rooms to ask which applies to you.
MEDICARE AND HEALTH FUNDS
How the pieces fit together
FIRST
The referral
Medicare rebates are available with a valid Medicare card and a current referral. A GP referral is valid for twelve months; a specialist referral for three. Without one, Medicare cannot contribute to the consultation fee at all.
THEN
The Medicare rebate
Medicare pays a scheduled amount for each item number. That amount is set by the Government rather than by the doctor, and for most specialist services it covers part of the fee rather than all of it.
IF INSURED
Your health fund
For surgery as a private inpatient, your fund contributes to the hospital account and to the medical accounts. Check that your policy covers the specific procedure, whether a waiting period applies, and what your excess is.
WHAT IS LEFT
The out-of-pocket amount
Whatever the rebate and the fund do not cover. This is the number that actually matters to you, and the one to ask for in writing before anything is booked.
The number that matters is the gap, not the fee
Private surgery in Australia generates several separate accounts, and knowing what one of them charges tells you very little. Ask for the total out-of-pocket amount across the hospital, the surgeon, the anaesthetist and the assistant, ask for it in writing, and ask before a date is booked rather than after. Informed financial consent is a normal expectation, not an awkward request.
WHAT TO ASK
Six questions that get you a real number
Informed financial consent means knowing what you will pay before you agree to it. These questions are entirely reasonable, and you should not feel awkward asking any of them.
What is my total out-of-pocket amount?
Not the fee, the gap. And across all the accounts, not just the surgeon's. Ask for it in writing.
Which item numbers will be billed?
With the item numbers you can check the Medicare schedule fee yourself and ask your health fund exactly what it will pay for each one.
Does a gap scheme apply to me?
The practice states that treatment can be provided through a medical gap scheme under some circumstances. Ask whether your fund and your procedure are among them.
What will the anaesthetist and assistant charge?
Separate providers, separate accounts. Ask the rooms who they are and request their estimates before the date is confirmed.
What will the hospital charge, and what is my excess?
Confirm with your health fund, not just with the hospital, that the specific procedure is covered at your level of cover and that no waiting period applies.
What happens if it costs more than expected?
If a longer or more complex operation becomes necessary, ask how that changes the estimate and whether you will be told before it happens where possible.
COMMON QUESTIONS
What people ask about cost
Why can you not publish a price?
Because there is not one. The figure depends on the operation, how many levels are involved, which implants are used, your level of private cover, your excess, and whether a gap scheme applies. A published number would be wrong for almost everyone who read it.
What if I do not have private health insurance?
The practice states that self-insured estimates are given for patients who do not have private health insurance, and that payment plans are available. Ask for the estimate early rather than at the end of the process.
Will Medicare cover the consultation?
Medicare rebates are available with a valid Medicare card and a current referral. The rebate covers part of a specialist consultation fee rather than all of it, and without a referral it does not apply at all.
What about WorkCover or DVA?
The practice sees WorkCover, DVA, Defence, interstate, overseas and medico-legal patients, and the billing arrangements differ between them. Mention which applies to you when you first make contact so it can be set up correctly.
Should I ask for the estimate in writing?
A written estimate is how informed financial consent is normally documented in Australian private practice, and it is a reasonable thing to ask any surgeon’s rooms for. Ask before a date is booked rather than after.
NEXT
Where to go from here
Do I need neck surgery?
The large majority of neck pain settles without an operation. Worth establishing before pricing one.
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Go to the form ›About this information
The statements about private fees, the medical gap scheme, self-insured estimates and payment plans are as published by the practice. Everything else on this page describes how private surgical billing works in Australia in general terms. No figures on this page are a quote, and your own out-of-pocket amount comes from the rooms, the anaesthetist, the hospital and your health fund. More about Dr Tollesson.
Ask for the number in writing. It is a normal thing to ask for.
Cost should be a known quantity before you agree to an operation, not a surprise afterwards. Reception is open Monday to Friday, 8:30am to 4:30pm.