The cost of private knee surgery as an uninsured patient
Private medical care for knee surgery is often preferable for many patients since it is more efficient in wait times.
Patients referred to the public system need a referral to the orthopaedic department from their GP. Once the referral is received, there is a considerable wait time to see a surgeon for an elective procedure.
Once the surgeon has seen you and has offered you surgery, you are placed on a waiting list. Patients get assigned into three categories: Category 1 patients having the most urgent problems, e.g. fractures and infections, are booked for surgery within 30 days. Category 3 patients have non-urgent conditions, and the waiting time for surgery is within 365 days. With the ongoing COVID-19 pandemic, waiting times have increased.
Navigating the cost of private healthcare can be confusing. If you are uninsured, it is still possible to have your surgery performed privately. There are several considerations outlined below.
Cost of surgery
Healthcare costs in private can be expensive. The factors involved in a hospital fee estimate are described below.
Hospital stay
The cost of your hospital stay depends on which hospital you are having your surgery and the number of days you are staying in the hospital. This fee covers food, nursing care and allied health services provided to you during your stay. On average, each night you stay in hospital costs $1000-$1500 per day.
Cost of the operating theatre
Each surgery is associated with one or several Medicare Benefits Schemes (MBS) item numbers. This determines the cost of using the hospital theatre.
Equipment used
Consumable equipment used in surgery is charged separately. Like knee arthroscopy and meniscectomy, certain types of surgery have no consumable costs as there is no consumable equipment used.
Orthopaedic implants and equipment can come at a considerable expense. This is because medical device companies have spent a significant amount of money researching and developing the product. For example, a single ACL fixation screw can cost around $450. A standard knee replacement prosthesis can cost $7,000 to $10,000.
Fees associated with the surgical team
Surgeon
After seeing Mr Pai and considering the option of private surgery, he will provide you with a surgical quote based on the MBS item numbers. You will receive a 75% reimbursement from the value of the MBS item numbers quoted.
Anaesthetist
Your anaesthetist will have a fee dependent on the length and complexity of the anaesthetic. You will receive a 75% reimbursement from the MBS item numbers quoted.
Surgical assistant
Your surgeons’ assistant will charge a fee that is generally about 20% of the surgeon's fee.
Other costs
Cost of investigations
Certain procedures require post-operative X-rays, blood tests and other investigations. These will all incur additional charges.
Costs of allied health equipment
It is important to be safe with your mobility and follow the appropriate post-operative precautions. This may involve renting crutches, a walking frame or shower aids.
Costs of rehabilitation
When preparing for surgery, you should consider the cost of post-operative physiotherapy and rehabilitation. The success of specific procedures, like ACL reconstruction, is highly dependent on appropriate rehabilitation.
Other considerations
Unexpected complications
There is a small risk you may have complications associated with the anaesthetic or the surgery. If this is the case, you may incur additional costs if you need an ICU admission, more surgery, or an extended hospital stay.
If your surgeon works in a public hospital, they may discuss the option of transferring your care there to avoid any significant financial burden to you.
Case examples of uninsured quotes
The following are examples of how much surgery in the private setting could cost. The examples serve as a guide and will vary between hospitals, surgeons and other members of the surgical team.
ACL reconstruction
Here is an example of how much ACL surgery could cost if you are uninsured.
Hospital overnight stay $1000
Theatre cost $2000
Cost of the ACL equipment (screws, buttons etc.) $2100
Cost of other theatre consumables $800
Surgeon fee $3000
This fee varies between surgeons, and the figure provided is just an example.
Anaesthetist fee $1000
This fee varies between anaesthetists, and the figure provided is just an example.
Assistant fee $500
TOTAL $10400
If you have a torn meniscus associated with your ACL injury, this may increase the equipment cost if the meniscus is repaired.
Knee arthroscopy and meniscectomy
Here is an example of how much a knee arthroscopy and meniscectomy could cost if you are uninsured.
As this is a day-case, there is no hospital overnight stay cost
Theatre cost $3000
Surgeon fee $1500
This fee varies between surgeons and the figure provided is just an example.
Anaesthetist fee $800
This fee varies between anaesthetists and the figure provided is just an example.
Assistant fee $300
TOTAL $5600
Considering surgery in a private hospital?
If you are uninsured and would like to consider surgery in a private hospital, please contact Mr Pai’s rooms. We will only be able to provide you with a formal quote after your consultation. This is because Mr Pai will need to determine the need for surgery, the type of surgery and its complexity before providing you with an accurate quote. To do this, he will need to take a history, perform a clinical examination and review your imaging findings.