I think most of us in South Melbourne have done the private health insurance maths at some point. Premiums go up every April, and this year they rose by an average of 4.41 per cent, the biggest jump since 2017. You weigh that against the Medicare Levy Surcharge and the Lifetime Health Cover loading, decide you’re probably young enough or healthy enough to get by without it and figure Medicare has your back if something goes wrong.
I’m not going to pretend that’s a bad decision. It’s a bet, and for a lot of people it’s probably the right one.
The trouble starts when a GP tells you your knee needs a scope, or a specialist mentions a hernia repair as casually as recommending a café. Suddenly the question isn’t “do I need insurance?” It’s “how long am I going to be waiting, and what are my options if I don’t want to?”
The short answer is that being uninsured doesn’t lock you into the public system. Here’s how it works.
Public surgery wait times in Victoria
If you’ve got a Medicare card, you can have surgery as a public patient in a public hospital at no cost. That’s a great thing and I don’t want to undersell it. The catch is time and choice.
In Victoria, a surgeon puts every planned surgery patient into an urgency category. Urgent cases are recommended to be treated within 30 days, semi-urgent within 90 days and non-urgent within 12 months. I’d guess a lot of common procedures, like joint replacements and hernia repairs, land in the slower categories. You also generally don’t get to pick your surgeon or the date. If you want to see what that looks like in practice, the Victorian Agency for Health Information publishes current hospital wait data. Fair warning: it’s the kind of reading that makes your knee ache a little more.
For plenty of people, the public route is the right call. For others, a long wait means months of pain, time off work or life on hold, and that’s where the private option starts to look interesting.
Self-pay surgery packages in Melbourne
Many private hospitals will treat uninsured patients who pay their own way. The old way of doing this was a bit like building flat-pack furniture without the instructions. You’d piece together separate bills from the hospital, the surgeon, the anaesthetist and whoever else was involved, and you wouldn’t really know the total until it was too late to back out.
The newer approach is a fixed-price surgery package. Instead of a string of invoices, you agree on one price up front for a set procedure. Mulgrave Private Hospital in Melbourne’s south-east is one hospital offering self-pay surgery packages for uninsured patients, covering procedures such as hip and knee replacements, hernia repairs, colonoscopies and gastric sleeve surgery.
I’m naturally a bit suspicious of anything sold as a “package”, so here’s what’s actually in them.
What’s included in a self-pay surgery package
Inclusions vary by procedure and hospital, but they typically cover hospital charges from admission to discharge, the surgeon’s and anaesthetist’s fees, any prosthesis (such as a joint replacement) and a post-operative consultation. Some also include take-home medication and a period of cover after the operation in case you need further care, subject to conditions.
The bit I’d pay closest attention to is what sits outside the package. Pre-surgery consultations, scans, pathology and rehab are the usual grey areas, and I doubt any of them come cheap.
How to pay for surgery without insurance
Surgery isn’t cheap, even at a fixed price. Some hospitals offer instalment plans so you can pay off the cost before your operation, which beats finding the whole lot in one hit.
Using your super to pay for surgery
You may have heard you can dip into your super early to pay for medical treatment. You can, on compassionate grounds, but the rules are strict and I think the idea gets thrown around a bit too casually. The Australian Taxation Office requires two medical reports, one from a specialist, confirming the treatment is necessary and not readily available through the public health system. It also describes this as a last resort, only after you’ve exhausted other ways of paying.
Any money you take out now also won’t be growing for your retirement. Talk to your super fund and a financial adviser before you go down this path. The ATO has more detail on compassionate release of super.
Questions to ask before booking self-pay surgery
If I were booking self-pay surgery, these are the questions I’d want answered first. What exactly does the price include and exclude? Who’s performing the operation and how much experience do they have with this particular procedure? What happens, and who pays, if there’s a complication or I need to stay longer than planned? What follow-up care is included once I’m home?
A good hospital should answer all of these clearly and in writing before you pay a cent. In Australia you should also receive informed financial consent, which basically means you understand the costs before treatment starts. No surprises in the letterbox three weeks later.
Is Mulgrave too far from South Melbourne?
Living in the inner city, I get the instinct to want everything within a tram ride. But for a planned procedure, a trip to Melbourne’s south-east makes sense if it means a shorter wait and a clear price. Mulgrave is within easy reach of the Monash Freeway and EastLink, and for most procedures you’d only make the trip a handful of times: for consultations, the surgery itself and a follow-up.
Do you need private health insurance for surgery?
No, but you do need a plan. If you’re facing elective surgery, talk to your GP about both the public and private routes, get a proper quote and weigh the cost against what waiting would mean for your health, work and life. I don’t think there’s one right answer here. I just wish more people knew the options existed before they found themselves limping into a GP clinic.
