Affordable Pricing

How Does Medicare Regard Weight Loss Surgery?

Unlike cosmetic surgery, Medicare considers weight loss surgery as a genuine health intervention.

Every surgical procedure that is supported by Medicare is listed in a large directory called the ‘MBS’ and each has its own unique Item Number.

Weight loss surgery is no different, the Item Numbers are Gastric Bypass - 31572, Sleeve Gastrectomy - 31575. This means that Medicare will partially cover the costs involved in your surgery. 

Private Health Coverage for Weight Loss Surgery

Furthermore, Private Health Funds will cover the hospital fees associated with any procedure that has an Item Number, including weight loss surgery.

Private Health Funds usually offer different levels of cover depending on your monthly premium or plan.

As is common with most procedures, there is usually an out-of-pocket ‘gap’ that the patient must pay to the hospital prior to their operation.

Known Gap Surgery

Our Weight Loss Surgery program has an out of pocket cost of $6,000, however, the true total cost when:
  • bed stay fees, 
  • theatre fees,
  • Anaesthetist fee 
  • equipment and prosthesis charges, etc 
are considered is between $12,000 - $16,000, which is covered by your private health insurance.

This demonstrates the real and valuable contribution that Medicare and the Private Health Funds make toward the cost of weight loss surgery.

By contrast, cosmetic procedures do not have an Item Number and do not attract any support from Private Health Funds or Medicare.

How to Find Out What Your Health Fund Will Cover?

Contact your Private Health Insurer and quote the Item Number for your procedure (e.g. Sleeve Gastrectomy (31575), Gastric Bypass (31572).


Sometimes it can seem a little difficult to get a straight answer!


Patients often report being told that they will be covered:

 

  • up to the ‘Scheduled Fee’, or
  • that ‘if Medicare will pay 75% then the Private Health Fund will pay 25%’, or 
  • ‘if the procedure has been recommended by a doctor for health reasons it will be covered’ etc. 

If you are still not sure, we can run a Health Fund Check for you.


All the financial details will be discussed on your first consultation.

‘Top Cover’ Patients

Unfortunately, the full costs involved in providing quality medical care are not adequately covered by the Gap Private Health cover fee arrangement.

Irrespective of your level of cover, most common surgical procedures performed under our private health system involves gap payments.

Weight loss surgery has even more costs, as multiple professionals are involved in your care such as dietitians and psychologists, and care by your surgeon needs to be lifelong.

After your procedure Mr Niazi's consultations will be bulk billed. You will still have an out of pocket cost for your dietitian appointments post operation. 

Public Hospital Cover

Depending on your level of cover, sometimes a patient might be told they are only covered as a Private Patient in a public hospital, don’t worry, if this affects you, our surgeons can perform your procedure in a public hospital as his private patient. 

There is no difference in the quality of the surgery or the aftercare, your 'out of pocket' gap will stay the same. c

Patients Not Covered by Private Health Insurance

If you are not covered at all because 

 

  • Your level of cover is only basic or covers ‘extras only’, or 
  • You are not insured

 

then you have one of 2 options: 

 

  • either upgrade your cover and wait 12 months, or 
  • enter our program as an uninsured patient (conditions apply, call for a quote)

 

This can be paid by releasing your superannuation, for more information please contact our rooms.

What is Not Included in the Program Fee?

We pride ourselves on being upfront and transparent with our costing.

We feel regular and an ongoing multidisciplinary Care Plan is important following weight loss surgery. We will not charge you any further costs for Mr Niazi's appointments post operation.

Furthermore, we guarantee the quality of our surgery, if corrective surgery is ever required down the track you will not be charged any further out of pocket costs by us.

However, it is strongly advised that an appropriate level of Health Insurance be maintained to cover any future hospital costs.

What are the Costs and Funding Options for Gastric Sleeve Surgery?

 

  • There are a number of factors which may influence the final cost of surgery including hospital fees and the price of medications.

 

We will be able to provide a more detailed quote after consultation.


Patients can choose from a variety of payment options available depending on their financial circumstances and insurance status:

 

  • For patients with private insurance, the upfront surgeon cost is $6,000 (Mr Mani Niazi).
  • For patients without private insurance the cost ranges from $18,000-$19,000 which can be paid through your superannuation as well.

 

Whether you hold private health insurance or you are uninsured there will be an assistant fee and anaesthetist fee for your procedure. Please call our rooms for a quote and more information.