How much will cataract surgery cost?
I offer fair pricing for uninsured patients who would like to pay for surgery out-of-pocket, and a predictable small gap if you’re using your private health. Most importantly, all patients can enjoy a personalised approach with a range of premium lens implant options.
Private health patients
I charge a fixed amount for cataract surgery which is the same for all patients. If you have private health insurance that covers cataract surgery, each health fund will reimburse a specific amount for the procedure. The difference between what the health fund pays and what the procedure costs is the “gap” which is your out-of-pocket cost. My fee is the same for all patients but health funds can differ a lot in what they reimburse, so your gap depends on what health fund you’re with.
If you’re not happy with the gap with your health fund, you have the option of switching to a better fund without losing any of your entitlements or waiting periods for the same level of cover. This can be done before your surgery date without delaying your operation. For more information, see below from the Commonwealth Ombudsman about your rights:
The right to change - A guide to transferring health insurance entitlements between health insurers or policies
The average gap is around $230. If there is a gap, this will be made clear in writing before your surgery.
Make sure you’re covered
Cataract surgery requires a day surgery hospital admission, and is covered by most private health funds under their “Gold” or “Top ” hospital cover. A few “Silver Plus” plans and customised cover might also include cataract surgery. At the time of booking surgery, my staff will give you the procedure item numbers you’ll need to quote to your health fund to check if you’re covered.
To avoid surprises you can also check with your fund before your clinic appointment — the most common item number for cataract surgery is 42702.
If you have only recently increased your cover, there may be a waiting period with your health fund — check with them to find out.
Self-funded patients
Patients who are not privately covered for cataract surgery can still have the procedure as a private patient with me at either Seaford, Eastwood, or Glenelg. In this case you pay the cost of the operation out-of-pocket, and are considered “self-funded”.
Self-funded fees vary depending on the facility, the lens choice, and the complexity of surgery. Because every eye is different it is impossible to give accurate fees on this website, but your particular fees will always be made clear in writing before booking and going ahead with surgery.
To give you a rough idea, some principles apply (all fees listed are per eye):
I offer affordable surgery without compromising quality — feel free to ring around to ensure you’re getting a fair price
The self-funded fee — total out-of-pocket-cost — ranges from $2550 to $3550.
Any difference in cost is due to your chosen lens implant (set by the lens company), and the hospital you have surgery at (hospitals set their own admission fees).
The total out-of-pocket fee is made up of the day surgery facility fee (equipment, nursing, etc), the lens implant, surgical consumables, the anaesthetist fee, the surgeon fee, minus any Medicare rebates
Are there any other costs?
All of the fees above are for the procedure itself. Other costs to be aware of are:
Post-operative eye drops: Around $15-30, paid to the pharmacy. Be sure to inform the day surgery if you have a health care concession card.
Appointment fees: All patients referred for cataract surgery will need a pre-operative appointment to confirm the diagnosis, carry out a comprehensive eye check, and take necessary eye measurements. Most parts of the appointment attract a Medicare rebate, but there will be a gap — please call the clinic for a fee estimate ahead of time. Clinic appointments and tests are not covered by your health fund (this is due to the rules governing private health funds). After surgery, there are no out-of-pocket costs for post-op reviews.
Health fund excess: Some health insurance plans have an excess, which is an amount you agree to pay when you use your health insurance, usually in return for lower premiums. This amount is your co-payment to the hospital/day surgery and is not charged by me or the anaesthetist.
If you’d like to book or enquire about cataract surgery, get in touch.