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How does health insurance cover spinal fusion?
All silver-tier health insurance policies must include spinal surgery, but we’ve found basic ones that’ll cover you from $22 a week.
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*Prices updated November 2024, in line with Finder's database of health insurance policies. Prices reflect the cheapest available for a single individual with less than $97,000 income and living in Sydney with a $750 excess.
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These products offer a balance between low pricing and more features.
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Great
Competitive products within their group.
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Standard
Usually these products would either have fewer treatments covered or higher pricing.
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Basic
Offering basic cover with limited features or higher pricing.
Key takeaways
Spinal fusion is a major operation and can cost over $50,000 in the private system.
Spinal fusion can be covered by Medicare or with private health insurance.
The operation is controversial, with critics calling is 'expensive, dangerous and ineffective'.
What is a spinal fusion?
Spinal fusion is surgery which permanently connects two or more vertebrae in your spine, thereby stopping motion between them and reducing pain. During the operation, your surgeon places bone (or a bone-like material) between the space in the two spinal vertebrae. Metal plates are often used to hold the vertebrae together, so they can heal as one solid structure. Spinal fusion surgery usually takes between 3 and 7 hours, using general anaesthetic the whole time. The typical hospital stay is between 2 and 7 days.
You might need spinal fusion for:
Spinal weaknesses. Your spine can become weak and unstable as a result of conditions such as severe arthritis in the spine or specific injuries.
Herniated disk. After the removal of a herniated disk, you might need a spinal fusion.
Spinal deformities. Spinal fusion is often used to treat spinal deformities such as scoliosis.
Possible dangerous of spinal fusion
We're not doctors, but you should know that spinal fusions are controversial. Critics say there's little high-quality evidence supporting the procedure for most back issues. Critics claim the treatment is expensive, often ineffective and that most back problems can be treated with less costly procedures. There is a lot of disagreement on this point, and the Medicare benefit for spinal fusions was almost amended in 2019 as a result. Be sure to do your own research before you make any major decisions.
Does Medicare cover spinal fusion?
In the public system, Medicare will cover the cost of medically necessary spinal surgery. You can find spinal surgery items within sub-group 17 (spinal surgery) of group T8 (surgical operations) on the Medical Benefits Schedule (MBS). Item numbers 51011 to 51171 cover various spinal surgery operations, including spinal fusions. Costs vary depending on the surgery and surgeon but for a rough guide, item number 51013 has a fee of $2,430.55.
In a private hospital, Medicare will also cover 75% of the MBS fee, with you and your private health care provider paying the rest. Fees in the private sector tend to be significantly higher than the public system, however.
How does private health insurance cover spinal fusion?
You should be able to find cover for spinal fusion with all silver tier hospital policies under back, neck and spine. Silver-tier policies cost from around $22 a week. Most policies come with a 2-month waiting period, or 12-months if you have relevant pre-existing conditions.
Hospital treatment with private health insurance for back, neck and spine usually covers the investigation and treatment of the back, neck and spinal column, including spinal fusion. This includes sciatica, prolapsed or herniated disc, spinal disc replacement and spine curvature disorders such as scoliosis, kyphosis and lordosis.
Compare health insurance that covers spinal fusions
Here are a few policies from Finder partners that cover back, neck and spine in their treatments. All prices are based on a single individual with less than $97,000 income and living in Sydney.
Each month we analyse over 10,000 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.
Spinal fusion in the private system without insurance costs from $25,000 to $58,000+. Surgeon's fees tend to be the main expense (from $14k to $35k+) but costs like hospital admission and anaesthetists also contribute. Here are some of the estimates we were able to find:
Source
Cost
Notes
Medibank
$42,226
Medibank's cost estimation comes from claims data from partner hospitals. It doesn't include additional out-patient costs.
HCF
$24,219 - $48,458
HCF's cost estimate varies based on a range of gap options and whether a partner hospital is used.
Out-of-pocket costs for spinal fusion
Before you agree to any complex procedure, make sure your health provider will cover you. Ask them about potential out-of-pocket expenses, such as consultation and anaesthesia fees. Be sure to ask for the MBS item number from the surgeon as well. That way, you'll have a good idea of any out-of-pocket expenses.
If you choose to go private, it's likely your health fund will have a No Gap scheme. Always ask the surgeon you use if they are participating in the scheme; this will keep out-of-pocket expenses to a minimum. Doctors' fees can vary significantly so it's smart to ask them about their fees before commencing treatment.
Because spinal fusion is a complex procedure, you may encounter out-of-pocket costs for an orthopaedic surgeon, specialist consultations, assistant surgeon, anaesthetist, pathologist and radiologist. Ask your health insurance provider about costs for these services before surgery.
How much does health insurance cost?
We ask hundreds of Australians what they're paying for health insurance every month. Here's what their bill looked like in October 2024.
Extras only: $60
Basic: $97
Bronze: $145
Silver: $176
Gold: $210
Price based on 500+ responses for single hospital or extras insurance.
Gary Ross Hunter was an editor at Finder, specialising in insurance. He’s been writing about life, travel, home, car, pet and health insurance for over 6 years and regularly appears as an insurance expert in publications including The Sydney Morning Herald, The Guardian and news.com.au. Gary holds a Kaplan Tier 2 General Advice General Insurance certification which meets the requirements of ASIC Regulatory Guide 146 (RG146). See full bio
Gary Ross's expertise
Gary Ross has written 649 Finder guides across topics including:
Tim Bennett is a Finder insurance & utilities expert. For over 10 years he's reported on news, politics, finance and other topics as a journalist and radio presenter. Tim's roles have included radio news reader and breakfast at the ABC, news producer for SBS and producer for Fairfax Media. Tim regularly appears as a health insurance expert on programs like Sunrise and SBS news, as well as in the Australian, The Daily Telegraph, The Courier Mail and more. See full bio
Tim's expertise
Tim has written 121 Finder guides across topics including:
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finder.com.au is one of Australia's leading comparison websites. We are committed to our readers and stands by our editorial principles
We try to take an open and transparent approach and provide a broad-based comparison service. However, you should be aware that while we are an independently owned service, our comparison service does not include all providers or all products available in the market.
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Depending on your age, you may be eligible for an
aged-based discount. This is used to estimate your
rebate.
Under 65
65 - 69
70 or older
What's your household's taxable income?
This is the combined income you and your spouse earn before tax. It's needed to calculate the correct Australian government rebate.
$93,000 and under
$93,001 to $108,000
$108,001 to $144,000
$144,001 and over
What kind of health insurance do you need?
Combined (Extras + Hospitals)
Extras
Hospital
What level of hospital coverage would you like?
You can change this at any time later.
Legend
Covered
Restricted cover, You may be partially covered for
this category.
Not covered. Optional for insurer to include.
*Prices updated March 2024, in line with Finder's
database of health insurance policies. Prices are based
on a single individual with less than $93,000 income and
living in Sydney with a $750 excess.
What extras cover do you need? (Optional)
Select as many as you want or move to the next step
Preventative & general dental
Major dental & implants
Optical
Physiotherapy
Podiatry
Non-PBS pharmaceuticals
Chiropractic
Emergency ambulance
Remedial massage
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