Get the lowdown on health insurance for appendicitis
Emergency appendix removal is partially covered by Medicare, while some private health insurance policies can cover the rest.
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If you're treated as a public patient in a public hospital, appendicitis surgery is generally free in Australia.
However, you'll have some out of pocket expenses if you get treated in a private hospital and don't have health insurance. For example, the fee listed on the Medicare Benefits Schedule for an appendicectomy is $463.50. As Medicare covers 75% or $347.65 of the scheduled fee, you'll need to pay the remaining 25% of the fee yourself — that's $115.85.
It's extremely unlikely to be that cheap though as doctors often charge much more than the MBS fee. You will also need to consider anaesthetist, assistant and diagnostic fees.
You'll find health insurance for appendix removal in all bronze level health insurance policies, but a handful of basic policies can cover you as well. We've listed them below alongside costs. Keep in mind that you'll have a 2 month waiting period for new conditions or 12 months for pre-existing ailments. All prices are based on a single individual with less than $97,000 income and living in Sydney.
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
Yes. If you're treated as a public patient in a public hospital, Medicare can cover 100% of appendix surgery expenses. Remember though, as a public patient, you generally won't be able to choose your own doctor or the day that you're admitted to hospital and receive surgery.
If you receive treatment as a public in a private hospital, the Medicare Benefits Schedule Fee (30720) for an appendicectomy is $463.50, of which Medicare covers 75%. However, doctors aren't obligated to stick to the MBS fee, so you might have to pay considerably more than the 25% if they do charge more.
You'll find appendix removal covered with all bronze tier health insurance policies under hernia and appendix. With private health insurance, you can choose your own doctor, hospital and in many cases, you'll get treated much quicker.
If you already have health insurance, chances are you've already served the waiting period as it's included in most policies.
The majority of insurers cover the cost of surgical and theatre fees, as well as for any medicine you receive whilst in hospital. It will also generally cover the cost of accommodation in a private hospital or bed.
There may be some out of pocket expenses if you don't have some form of gap cover. To have a good indication of any out of pocket expenses, you should find out the price of the following:
Health fund | What services are covered? | Apply |
---|---|---|
AHM hospital cover policies cover the surgical removal of your appendix if you have appendicitis and need hospital treatment except for Starter Basic Hospital cover. This includes all agreed hospital charges in a partner private hospital in a shared or private room. In a public hospital, AHM will cover accommodation charges for a shared room and pay benefits towards the cost of a private room. A 12-month waiting period applies for pre-existing conditions, but this is shortened to two months in all other cases. | ||
If you require appendix removal, hospital cover from Australian Unity covers hospital accommodation costs, theatre fees, in-hospital pharmaceuticals and more . A two-month waiting period applies. | ||
GMHBA Hospital Cover includes cover for theatre fees, doctor's fees and accommodation in a public or private hospital when you need to have your appendix removed except for Basic Plus (Restricted). Pharmaceuticals you receive as an inpatient are also covered. A two-month waiting period applies. | ||
HCF Hospital Cover provides cover for the cost of an appendectomy, including hospital accommodation, theatre fees, surgical fees and pharmaceuticals. Whether or not you receive treatment in a private or public hospital varies depending on the level of cover you select. A two-month waiting period applies. | ||
If you need to have your appendix surgically removed, cover is provided by HIF's suite of health insurance policies. This includes accommodation in a private hospital or as a private patient in a public hospital, plus theatre care, surgical fees and pharmaceuticals you receive in hospital. A two-month waiting period applies. | ||
All of Transport Health's hospital cover policies include cover for appendix removal. This includes hospital accommodation, emergency ambulance transport, theatre fees and pharmaceuticals. A two-month waiting period applies. |
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