Knee Replacement Costs

karenestelle on 05/02/2019 - 09:10
Last edited 05/02/2019 - 10:06 by 1 other user

I am a candidate for a knee replacement. I am covered for Private and have visited a specialist and been given a quote. I have an excess for my health fund of $500 so taking this into consideration all up I will be $4,300 to $4,500 out of pocket.

Yesterday I talked to a family friend who has had a knee replacement just 3 weeks ago. He is located on the Central Coast whilst I am in Sydney. He tells me his out of pocket was a mere $750 so I calculate since he has only $250 excess this is a difference of $3,500 for out of pocket expenses. It has been suggested to me to shop around but I find this difficult to do.

I would love to learn of any experience anyone can share with me as to whether the amount I will be out of pocket is reasonable. Any advice you can share with me would be greatly appreciated.

Thank you.

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  derpdeder on 05/02/2019 - 10:02

  +1

  Talk to your private health insurer about your options first instead of just going with your GPs recommended surgeon. Your private health provider will have network doctors. Usually the list is searchable on their website. Check that list for orthopedic surgeons that perform knee surgery near you or get the PHI to do it. They have an agreement where they minimise the gap.

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  Trying2SaveABuck on 05/02/2019 - 10:24

  No idea what your private health insurer will cover and it might be different in NSW but the total cost of the Total Knee replacement (TKR) is around 15-25k this includes the whole procedure and rehabilitation post-operative.

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  Topdog on 05/02/2019 - 10:27

  If you go on a waiting list, its cheap, if you go elective or do not wait, it costs around 4-5k

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  elgrande on 05/02/2019 - 10:38

  How long is the waiting periid for public hospitals?

  • 

    Topdog on 18/02/2019 - 15:33

    it was 14 months, a few years back when I had a family member go though it! not sure now

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  sghetti on 05/02/2019 - 10:44

  The additional costs can be that the surgeon you've seen charges above the prescribed costs/cover that your insurer covers on the standard item.

  It could be worth shopping around, but you also want to ensure you get it done right :)

  As others have mentioned, public waiting lists would reduce the costs, but you could be waiting for a long time.

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  Blue Suby on 05/02/2019 - 12:08

  Another cost is the knee implant itself. There are newer (expensive) ones that cost more than older (cheaper) types and depending on your age. health etc. some of the older ones can cause metal particle migration after time. Dearer is not necessarily better.

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  CheapskateQueen on 05/02/2019 - 12:48

  yeh you can't really compare. Every surgeon charges different fees, as does each anesthetist. The implant itself is usually covered by PHI but you should check that as well.

  this is how it works:
  1. Medicare sets prescribed fees for different "Items" - every aspect of your surgery has an item number with a prescribed cost. These amounts are low and not representative of what surgeons charge. e.g. $1000
  2. Medicare covers 75% of the prescribed fee. e.g. $750
  3. Your Private Health Fund covers the 25% difference of the prescribed fee. $250
  4. You pay out of pocket for the amount your surgeon & assistant surgeon & anesthetist charge over and above the Medicare Item prescribed fee. E.g. $5000 actual fee less $1000 (75% medicare + 25% insurance) = $4000 out of pocket
  5. Your insurance covers your hospital stay, operating theater, tests, most likely implants etc

  Your insurance may offer "no gap" surgeons so you could check for that if you wanted to go cheaper - this would mean that you pay your insurance excess only. Speak to your insurance to see if they have a no gap option and a list of surgeons available. I can't speak to the caliber of surgeons that do this - there may be no relationship and just cheaper surgeries and an insurance alliance mean more customers, or it may be reflective of experience. Who knows.

  You could also get a quote from the surgeon that your mate went to if you were willing to travel to his/her hospital.

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  Findo on 05/02/2019 - 14:02

  -1

  The skills of the surgeon outweigh any potential savings gained by shopping around or waiting for a public doctor. Choice is important.

  I highly recommend Dr Simon Tan of St Vincent’s Sportsmed, top bloke and excellent skills + bedside manner.

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    Forfiet on 05/02/2019 - 19:04

    Also if they use the assistance of a mako(?) surgery robot it can make the operation easier on the patient and the doctor….

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  matt3 on 05/02/2019 - 19:00

  +2

  Waiting for a comment from the OzBargain Bikies - they're always breaking knees.

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    [Deactivated] on 05/02/2019 - 19:29

    Same. Surely someone will mention it soon.

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  AFM on 06/02/2019 - 10:16

  I had a similar procedure (partial knee replacement) just over a year back and my out of pocket expenses were around $1200, which included 4 days in hospital as a private patient.
  The total cost was around $22,000 in Perth.
  Every case and person is naturally different, as we know, there’s no one size fits all but it was the biggest regret of my life for not making a personal concerted effort to investigate what other options were available to me, rather than just listen to my GP & the surgeon.
  Hey there’s no photoshopping or changing of the mind policy once the leg & knee have been cut, it really is permanent.
  In my case and in hindsight, physiotherapy and targeted exercises could well have been the better option, because the knee still regularly gives lots of pain, although the procedure was reported as being successful.
  My suggestion is to do plenty of homework first because there is no going back once the go button has been pushed and good luck with it.

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  sauce2k on 19/02/2019 - 23:13

  That cost sounds about right to me…knee replacement is a pretty big and $ surgery.

  I just saw a surgeon today (he's got a good reputation) for ACL reconstructive..to get both my knees done I'm about $5k out of pocket excluding hospital excess, assistant surgeon fee and anaesthetist cost…

  I called Medbank they mentioned something you need to speak to your surgeon to see if she/he wants to participate this gap cover thing, which I didnt quite get it..waiting for an email from Medbank to explain further..what it does is that if the surgeon agrees to it, then he/she will need to negotiate with Medbank then Medbank will cover a bit more.