Knee arthroscopy cost
Expert tips for health insurance
Our health insurance expert, Steven Spicer, has some handy tips for choosing the right health insurance for your knee arthroscopy.
Steven Spicer
Executive General Manager – Health, Life & Energy
Discuss your surgery with your doctor
Knee arthroscopy is an effective means of seeing inside your knee and performing keyhole surgery. However, there may be other options that will suit you better. Your medical professional may recommend physiotherapy or an MRI scan before resorting to a knee arthroscopy.
Choose the right level of cover
When choosing a policy, knowing the right level of cover for your needs is key. To help you decide, consider your health needs, family history and healthcare services you’ll likely use. Choosing the right level of cover will help you get the benefits you need without paying for inclusions you won’t use.
Compare your cover often
We all change over time and this includes our healthcare requirements. Checking your cover regularly provides you an opportunity to make sure your policy suits your current needs. It allows you to add cover you need (simply serve the relevant waiting periods when upgrading) and remove anything you no longer require.
What is a knee arthroscopy?
A knee arthroscopy is a keyhole orthopaedic surgery that is used to examine and diagnose issues inside the body.1 A small tube with a camera attached (an arthroscope) will be inserted into a small incision in the knee. Depending on the issue, your knee condition may be able to be diagnosed and treated within the same knee surgery. Some ligament reconstruction or meniscal repair can be performed during the knee arthroscopy without the need to make a larger incision.
A knee arthroscopy procedure can help diagnose and possibly treat:1
- A torn meniscus (knee cartilage)
- Torn anterior cruciate ligament (ACL)
- Osteoarthritis
- Damage to the knee joint.
An orthopaedic surgeon will perform the procedure. Usually, knee arthroscopies are day procedures (though there are exceptions), but it will take a few weeks to recover completely.
Are there any alternatives to knee arthroscopy?
If you have knee pain, your doctor may recommend other treatments before trying a surgical procedure.1 Physiotherapy or inflammatory medication (ibuprofen, etc.) may help manage pain and delay the need for surgery. When physical therapy and pain relief medication are no longer efficient, surgery will be considered.
Depending on your knee problem, an MRI may be able to diagnose the problem or potentially rule out anything that would require keyhole surgery. If you need treatment, you still may need an arthroscopy.
How much does a knee arthroscopy cost in Australia?
The cost of your knee arthroscopy can vary depending on the Medicare Benefits Schedule (MBS) item number; these numbers are 49576, 49580, 49572, 49582 and 49578, with each one denoting a different type of knee arthroscopy .2
However, in general, the typical specialist fee may be $2,200. Medicare pays $790, and your health fund typically pays $820. Patients have out-of-pocket expenses of around $500. However, this can vary depending on your specialist, insurance policy and procedure. There are also hospital fees (e.g. hospital stay, theatre fees), which typically cost $1,900 for a knee arthroscopy procedure.
These figures are intended as a guide and shouldn’t be considered quotes. Arthroscopic surgery can vary in complexity and scope, meaning prices can differ on a case-by-case basis.
Does private health insurance cover knee arthroscopy?
Private hospital cover can contribute towards a knee arthroscopy, providing you have the right level of cover. Your policy will need to include the clinical categories ‘joint reconstruction’ and ‘bone, joint and muscle’, which are minimum requirements for Bronze, Silver, and Gold tier hospital cover
Private health insurance allows you to be treated as a private patient in a private hospital, which has the following benefits:
- Avoid public hospital waiting times
- Choice of specialist and healthcare facility
- Private room (subject to availability).
Keep in mind that with any procedure, there may be a ‘gap’ between the MBS fee and the specialist fee. Depending on your policy, you may have to pay out-of-pocket for some or all of this gap payment.
Does Medicare cover knee arthroscopy costs?
Medicare will cover the costs of a knee arthroscopy performed as a public patient in a public hospital and some of the MBS fee if you’re treated in as a private patient. Your insurer will cover the remaining fee amount, if you have the right cover.
While public hospitals provide a valuable service, there are some downsides. Due to high demand, the public system has a long waiting list, which could lead to you waiting months for your treatment. You’ll also have little say over where your procedure is performed and when.
Is there a waiting period for knee arthroscopy?
If you’re taking out health insurance for the first time, you may have to serve a waiting period before you can make a claim. These waiting periods can also apply if you’re upgrading your policy and want to claim on an inclusion you didn’t previously have. Joint reconstruction and bone, joint and muscle typically have a waiting period of two months. If you’re considered to have a pre-existing condition, the waiting period will be 12 months.
If you switch policies but have already served your waiting period for joint reconstruction and bone, joint and muscle, you won’t have to serve it again.
Meet our health insurance expert, Steven Spicer
As the Executive General Manager of Health, Life and Energy, Steven Spicer is a strong believer in the benefits of private cover and knows just how valuable the peace of mind that comes with cover can be. He is passionate about demystifying the health insurance industry and advocates for the benefits of comparison when it comes to saving money on your premiums.
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1 Health Direct- Arthroscopy of the knee. Accessed November 2024.
2 Medical Costs Finder – Knee arthroscopy. Accessed November 2024.