How does health insurance cover brain surgery?

Compare health insurance quotes for brain surgery and treatment

Here are some Finder policies that will cover some of the cost of brain surgery in a private hospital. All prices are based on a single individual with less than $97,000 income and living in Sydney.

Finder Score - Hospital cover health insurance

Each month we analyse our hospital insurance products and rate each one on price and features. What we end up with is a nice round number out of 10 that helps you compare hospital cover a bit faster.

Before we start scoring, we need to make sure we're comparing like-for-like. Just as it doesn't make sense to compare a bicycle with a Ferrari, it doesn't make sense to compare basic hospital policies to top-tier Gold policies. Each policy is given a price score and feature score. These are then combined to determine each policies's Finder Score.

Read the full Finder Score methodology

How can I pay for brain surgery?

Both Medicare and private health insurance can contribute towards the cost of brain surgery.

How does medicare cover brain surgery and treatment?

Medicare will usually cover the cost of staying and being treated as a public patient in a public hospital. You generally won't be able to choose your own doctor or choose when you want to undergo brain treatment or surgery. This is largely because public waiting times are normally longer as they're busier, so you don't have the same flexibility as you would with private health care.

Medicare will also pay a benefit towards seeing a specialist, such as a neurosurgeon. The neurosurgical consultation structure consists of an initial consultation (Medicare Benefits Schedule no. 6007) and four categories of subsequent consultations. These categories relate to both the length of consultation time and the complexity of what is being discussed. Here's a break down of some of the prices (correct as of 7th September 2021):

• Level 1. 6009 - Fee: $45.40 Benefit: 75% = $34.05, 85% = $38.60
• Level 2. 6011 - Fee: $90.35 Benefit: 75% = $67.80, 85% = $76.80
• Level 3. 6013 - Fee: $125.15 Benefit: 75% = $93.90, 85% = $106.40
• Level 4. 6015 - Fee: $159.35 Benefit: 75% = $119.55, 85% = $135.45

Medicare also provides cover for deep brain stimulation, which is sometimes required for Parkinson's disease or for treating tremors or dystonia. Because there are so many different types of brain treatment, you should consult your local Medicare office to find out exactly what you're covered for.

How does private health insurance cover treatment?

You can get private health insurance for brain and nervous treatment with all bronze tier hospital policies. Costs generally range from around $88 a month and includes cover for:

• Investigation and treatment of the brain
• Brain-related conditions
• Spinal cord and peripheral nervous system
• Chemotherapy, radiotherapy and immunotherapy for cancer (these come under a separate service but are also included in all bronze policies)

You will generally have to serve a waiting period of 2 months (12 months for pre-existing conditions) before you can claim though you will get to choose the doctor of your choice and treatment is generally very quick.

Frequently asked questions

• What is brain surgery?

  Brain surgery, also known as neurosurgery, is a medical specialty that involves the surgical treatment of conditions and disorders of the brain, spinal cord, and nervous system. This includes diagnosing and treating conditions such as brain tumors, aneurysms, hydrocephalus, and traumatic injuries. It also involves performing procedures such as deep brain stimulation and shunt placement to manage symptoms and improve function.

• What conditions can be treated with brain surgery?

  Brain surgery can be used to treat a wide range of conditions, including brain tumors, epilepsy, aneurysms, hydrocephalus, and traumatic injuries. It can also be used to perform procedures such as deep brain stimulation and shunt placement to manage symptoms and improve function.

• Is brain surgery safe?

  Brain surgery is a complex and delicate procedure, and as with any surgical procedure, there are risks involved. However, advancements in medical technology and surgical techniques have greatly improved the safety and effectiveness of brain surgery. The risks and benefits of the procedure should be discussed with a neurosurgeon before making a decision.

• Is brain surgery covered by private health insurance in Australia?

  Private health insurance policies in Australia generally cover the cost of brain surgery, including the procedure and any necessary hospital stays and follow-up care. However, the extent of coverage may vary depending on the policy and the individual's circumstances. It is important to check with your health insurer before the surgery to understand your coverage.