Costs of Surgery
There is universal health cover in Australia from Medicare. This means that all Australian residents are covered by the public health system.
The private healthcare system provides several benefits, including the ability to choose your surgeon, shorter wait times, and access to a wider range of procedures that may not be offered in the public system. However, these advantages come with out-of-pocket expenses.
While Medicare covers a portion of medical fees, private health insurance generally contributes only a limited amount toward doctors’ fees. Most of your insurance cover is directed toward hospital-related costs rather than the surgeon’s charges.
When consulting with Mr Ben Dowdle, you can typically expect the following fees:
Initial consultation: $250
Follow-up consultation: $110
Surgical costs (if required): These vary depending on the specific procedure, your health fund, and your level of cover
This section aims to provide you with some basic financial information about the Private Health system.
Orthopaedic Surgery Costs
Surgery involves a number of separate fees. Many patients assume they are paying only for the surgeon, but in reality, multiple providers are involved, each billing separately—both to you and your insurer.
These may include:
Surgeon’s fee: Typically calculated as a percentage of the Australian Medical Association (AMA) recommended fee, depending on your health fund
Anaesthetist’s fee: Usually involves an out-of-pocket gap based on the complexity of the surgery and your individual anaesthetic needs. The anaesthetist will contact you before surgery to discuss and confirm costs
Assistant surgeon’s fee: Generally includes a gap fee of between 10-20% if your surgeon’s fee
Hospital and theatre fees: For insured patients, this is usually limited to your policy excess. However, some orthopaedic procedures may not be covered, so it’s important to confirm with your insurer in advance
Pathology and radiology: Tests such as blood work and imaging performed during your hospital stay may incur additional charges
Implants and prostheses: Often covered by insurance, but it is advisable to verify this with your provider beforehand
Most orthopaedic consultations and procedures are linked to Medicare item numbers. As long as you are eligible for Medicare, you will receive a rebate for many of these services.
Surgeon’s fees and ‘gap’ payments
All orthopaedic procedures are linked to Medicare item numbers, which means you will receive a rebate from Medicare. Private health insurance may also contribute an additional amount—usually up to 25% of the Medicare rebate.
A surgeon’s fee does not only reflect their personal income. It also helps cover the costs of running a medical practice. This includes staff wages (such as nurses, receptionists, and administrative staff), as well as expenses like medical equipment and supplies, rent, utilities, cleaning, computers, ongoing training, accreditation, and professional insurance.
Since Medicare was introduced over 40 years ago, the rebates set by the government have not kept pace with the real costs of providing medical care. As a result, there is often a difference between what your doctor charges and what Medicare and your health fund will pay. Most surgeons will charge AMA (Australian Medical Association) rates for their services. This is almost three times the Medicare rebate and reflects the true discrepancy.
This difference is known as a ‘gap’ or ‘out-of-pocket cost’—the amount you may need to pay yourself.
Ben aims to keep any out-of-pocket costs as low as possible and will discuss all fees with you clearly during your consultation. You are always encouraged to ask questions, so you feel fully informed and comfortable before proceeding with treatment.
For a more detailed explanation of ‘gap’ payments, please refer to this AMA article.
Understanding Health Insurance Cover
Not all private health insurance policies offer the same level of cover.
Some lower-cost policies (sometimes referred to as “basic” or “restricted” cover) may exclude certain procedures or only provide limited benefits. While these policies can reduce government surcharges, they may leave you with higher out-of-pocket costs if you choose to have surgery in a private hospital.
It’s important to carefully check your policy to understand:
What procedures are included
Whether orthopaedic or joint replacement surgery is covered
What hospital costs are paid for
If you’re unsure, Ben’s receptionist, Millie can help guide you on what to ask your insurer.
For Patients Without Private Insurance
If you do not have private health insurance, you can still choose to have surgery as a private patient.
In this case, you will receive quotes from the hospital and any implant providers. Medicare will still cover part of the surgeon’s fees, which helps reduce your overall costs.
Ben regularly treats uninsured patients and is happy to discuss all available options with you during your consultation.
Upper Limb Orthopaedic Surgeon Melbourne
Utilising the latest techniques for upper limb surgery, Ben aims to get you back to your best as quickly as possible.