Understanding a surgery quote: what to ask before you agree
Before private surgery you should get a written estimate of all costs. Here's what a good quote includes and what to ask.
If you're having surgery or a procedure as a private patient, there can be several bills: the surgeon, the anaesthetist, sometimes a surgical assistant, the hospital, and any tests or devices. Knowing these costs before you agree to treatment is called informed financial consent.
Who should give you a cost estimate
Each doctor involved should tell you their fees before treatment, ideally in writing. This includes:
- Your surgeon, whether in General surgery, Orthopaedic surgery, ENT surgery, Urology or another field
- The anaesthetist, who usually bills separately
- A surgical assistant, if one is used
- The hospital, for bed, theatre and other charges
- Your health insurer, for what your policy will pay
If the surgeon's rooms only quote their own fee, ask for the anaesthetist's name and contact details so you can request their estimate too.
What a good quote includes
- The procedure name and the Medicare item numbers
- Each doctor's fee
- The Medicare rebate and what your insurer will pay
- Your expected out-of-pocket cost for each doctor
- Whether the doctor uses your insurer's gap cover arrangement
- Any separate costs, such as follow-up visits, devices or pathology
Your insurer can only tell you what it will pay once you give them the item numbers and the hospital name. Call them with the quote in front of you.
Questions to ask
- Is this an estimate or a fixed price? What could make it change?
- Are follow-up appointments included?
- When do I have to pay, and is a deposit required?
- What happens to the cost if the surgery changes on the day?
- Is there a public option for this procedure, and what is the wait?
It's OK to take time to think, to compare quotes or to get a second opinion before you agree. See How to get a second opinion from another specialist. The Australian Government also publishes a Medical Costs Finder that shows typical costs for common procedures.
If you have no private cover
Keep all your quotes and receipts together. They help if you need to check a bill later, and they also help you track costs towards the How does the Medicare Safety Net work? for any related visits outside hospital, such as follow-up appointments or scans.
Before an emergency operation there may be no time for a quote. In that case, the doctors and hospital should explain the costs as soon as they reasonably can afterwards.
Self-funded patients pay the full hospital and doctors' fees, with Medicare paying a rebate on the doctors' fees only. Ask for an all-inclusive estimate. Treatment as a public patient in a public hospital is free. See Public or private: how to choose where to see a specialist.
Common questions
What is informed financial consent?
It means you've been told, before treatment, what the costs will be and what you'll pay yourself, so you can decide with full information. It should come from every doctor involved and the hospital.
Why did I get a bill from someone I didn't meet?
Anaesthetists, assistants and pathology services often bill separately. Ask your surgeon's rooms in advance who else will be involved.
Can I ask for a cheaper option?
Yes. You can ask whether the surgeon uses your insurer's gap cover, compare other surgeons, or ask about the public system.
What if I'm charged more than the quote?
Contact the doctor's rooms first. If you can't resolve it, you can contact your health insurer or the Private Health Insurance Ombudsman.
General information only, not medical advice. Everyone's situation is different, so check with your GP or the provider. In an emergency call 000.