If you require day surgery or surgical procedures where you’ll be admitted and discharged from the hospital on the same day, chances are you’ve asked about private hospital day surgery fees.
The cost of day surgery in private hospitals can differ widely, depending on the treatment you’re receiving, where you’re being treated and who’s treating you. You could receive the same high-quality, state-of-the-art procedure in QLD, NSW, VIC or elsewhere in Australia but pay different fees.
Day procedures may be available for health specialty areas, including orthopaedic, paediatric, gynaecology or urology services. This depends on the type of health care required and the surgical services used.
Day surgeries require formal admission into the hospital or facility for treatment to be covered by your health insurance policy. The treatment you need must be an inclusion on your chosen policy and you may or may not be required to pay the excess or co-payment when you’re admitted.
Based on your type of policy and choice of insurer (including your insurer’s gap cover agreement, which we discuss further on) your cover may go towards:
Despite paying for private health insurance, the total cost of your day surgery may not be covered by your policy.
Regarding any private day hospital admission, all procedures carry a government-assigned Medicare item number. Each item number is assigned a government-agreed cost or value under the Medicare Benefits Schedule (MBS) for the surgeons and anaesthetist costs. When it comes to claiming, Medicare covers 75% of the MBS cost of procedures, while your private health insurance will cover the remaining 25% of the MBS cost.
Example: The MBS fee for a grommet myringotomy (a surgery where a small cut is made in the eardrum to relieve pressure or to insert grommets) is $248.45.4 Medicare will pay $186.35 (75%) of the total $248.45, meaning your insurance would cover the remaining $62.10 (25%). Separately to this, your private health insurance policy may also cover the other costs of your hospital admission, such as theatre fees, medication, dressings and additional testing. It’s common to also be out of pocket for the excess amount on your chosen policy.
There are cases where health professionals will charge more than the MBS fee. As such, you may need to pay what is known as the ‘gap’ or out-of-pocket expense to cover these private hospital day surgery fees.