Moneyadviceblog » Medical Insurance » How Does Surgical Billing Work In Australia?

Surgical billing in Australia can be a complex process that involves multiple parties, including the surgeon, the hospital, and health insurance companies. In this blog post, we will explore how surgical billing works in Australia and what patients can expect when undergoing surgical procedures.

When it comes to surgical procedures in Australia, the costs can vary greatly depending on the type of surgery, the hospital, and the surgeon performing the procedure. Generally, surgical procedures in Australia are divided into two categories: elective and non-elective surgeries.

Elective surgeries are those that are not considered to be urgent or life-threatening and can be scheduled in advance. Examples of elective surgeries include cosmetic procedures, joint replacements, and cataract surgery. On the other hand, non-elective surgeries are those that are considered to be urgent or life-threatening and must be performed as soon as possible. Examples of non-elective surgeries include emergency appendectomies and heart surgeries.

The cost of surgical procedures in Australia is typically covered by a combination of Medicare and private health insurance. Medicare is a publicly funded healthcare system that provides basic healthcare services to all Australian citizens and permanent residents. Private health insurance, on the other hand, is an optional service that provides additional benefits not covered by Medicare, such as access to private hospitals and specialist care.

When it comes to surgical billing, the cost of the procedure is usually divided into two parts: the surgeon’s fee and the hospital’s fee. The surgeon’s fee is the amount that the surgeon charges for performing the procedure, while the hospital’s fee is the amount that the hospital charges for the use of its facilities and equipment.


In Australia, Medicare sets a schedule of fees that doctors and specialists can charge for their services. This schedule of fees is known as the Medicare Benefits Schedule (MBS). The MBS outlines the fees that Medicare will reimburse for various medical procedures, including surgical procedures. The MBS fee for a surgical procedure is typically lower than the actual fee charged by the surgeon.

When a patient undergoes a surgical procedure, the surgeon will typically charge their fee based on the MBS fee or a fee that is slightly higher than the MBS fee. The patient will be responsible for paying this fee, but they may be able to claim a portion of the fee back from Medicare or their private health insurance provider.

The hospital’s fee for a surgical procedure will depend on a number of factors, including the type of procedure, the length of the stay, and the level of care required. Private hospitals typically charge higher fees than public hospitals, but they also offer a higher level of service and greater comfort for patients.

If a patient has private health insurance, their insurer will typically cover a portion of the hospital’s fee, depending on the level of coverage they have. However, patients may still be required to pay an out-of-pocket expense or gap fee to cover the difference between the hospital’s fee and the amount covered by their insurer.

It is important to note that not all surgical procedures are covered by Medicare or private health insurance. Some procedures, such as cosmetic surgery, may be considered to be elective and, therefore, not covered by Medicare or private health insurance. Patients who are considering undergoing a surgical procedure should check with their surgeon and their health insurance provider to determine what costs will be covered and what costs they will be responsible for.

In conclusion, surgical billing in Australia can be a complex process that involves multiple parties and varying costs. Are you a provider seeking help managing your billing while you focus on providing life-saving and life-changing medical care? Then get in touch with Anaesthetic & Medical Billing Services Pty. Ltd today!