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Financial Support before Surgery

By Dr Jocelyn Lowinger

Surgery can be expensive—not only are there costs directly related to the procedure, but you also have to consider income lost from taking time off work to prepare and recover from your procedure. However, there are supports available to assist you financially through this period.


Private health insurance

Private health insurance can help cover your accommodation costs, theatre fees, and other charges for surgery in a private hospital (or as a private patient in a public hospital).


What you are covered for depends on factors such as your level of cover, the hospital you go to, and the fees charged by your surgeon and anaesthetist.


Insurance will generally cover the costs of the surgeon and anaesthetist up to the Medicare Benefits Schedule (MBS) fee. If they charge more than this then you will need to cover the remainder, or gap, from your own pocket. This is called a “gap fee” or “out-of-pocket” expenses.


Similarly, if you are having a joint replacement, depending on the type of prosthesis you are receiving, the cost of the prosthetic joint may be fully or partially covered which may leave you with another gap to pay.


Many health funds have arrangements with selected hospitals and doctors to help control your out-of-pocket costs.


Check with your doctor and your fund in advance to see what gaps or out-of-pocket costs you can expect, whether you will be able to control these through any special arrangements.  Also ask any other questions you have about the costs of your procedure beforehand. This will help prevent any unexpected surprises.


If you are eligible for Medicare and are having your procedure in a public hospital as a public patient, then Medicare will cover your treatment and accommodation costs for your procedure.


Disability insurance

The National Disability Insurance Scheme (NDIS) was launched in 2013 and is gradually being rolled out in selected locations across Australia to support people who have permanent and significant disability. To be eligible for the NDIS, you must be under 65 and the NDIS must be available in your area. See the checklist  to determine if you are eligible.


People eligible for the NDIS have access to:

  • Individualised plans
  • Community services
  • Funding to access ongoing services or one-off support, for example, to buy a wheelchair or pay for home modifications.


Government allowances

Government allowances available for people with an injury or disability include:


If you have a physical impairment and cannot work for fifteen or more hours per week within the next two years, you may be eligible for the disability support pension.


If you are between 22 years and the pension age and cannot work around the time of your procedure, you may be eligible for Sickness Allowance.


If you are unable to use public transport without substantial assistance after returning to work, you may be eligible for Mobility Allowance. This allowance is not available if you are receiving support from NDIS.


For more information on these allowances and eligibility criteria see the Department of Human Services.


Jocelyn is a doctor and professional health and medical writer with 20 years’ experience in the health industry. She has extensive experience in a range of approaches to improving the delivery of healthcare such as clinical governance, quality use of medicines, and developing high-quality health communications for consumers and health professionals.