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Cataract Surgery Cost

How much does cataract surgery cost?

Medicare or private health insurance pays for most and sometimes all of the cost of cataract procedures with out of pocket expenses ranging from $0 - $370. If you don't have private health insurance Cataract Surgery SA also caters for self funded cataract surgery which can be discussed at the time of your consultation.

Private cataract surgery expenses are met by a combination of some, or all, of:

  1. Medicare
  2. Private Health Insurance
  3. Your out of pocket expenses

This should be summarized in written informed financial consent given to you before you consent to cataract surgery.

Medicare

If you have a Medicare card, Medicare will contribute towards the costs of your cataract surgery.

Medicare will also reimburse you for some of the costs of your initial consultation with your preferred private cataract surgeon, and for some of the costs of the necessary tests that must be performed prior to cataract surgery performed in your cataract surgeon’s rooms. Note that:

  • In doing so Medicare is reimbursing the patient towards the costs of seeing a doctor. Medicare is not paying your doctor. If you are bulk billed, the money goes on your behalf straight to the doctor, in return for which you are not charged a gap.
  • For Medicare to give you money, Medicare requires you to have arranged for a current referral from an optometrist or GP to be at the cataract surgeon’s rooms by the time of your appointment. The is Medicare’s rule, not the specialists. Referrals cannot be backdated. The responsibility for the referral being current and at the cataract surgeon’s rooms at the time of your appointment is yours as the recipient of the Medicare money, not the doctors or their staff. Again, these are Medicare’s rules, not those of individual specialists or their practices.

Private Health Insurance

    • Fees paid by private health insurance to cataract surgeons for cataract surgery have decreased over time compared to costs of living. In addition there was a 20% sudden reduction in the fee paid for cataract surgery a decade ago. As a result, many cataract surgeons now charge a gap for cataract surgery.
    • May charge their clients an excess for making a claim on their insurance, just like car insurers do. Private Health Insurers usually ask the day surgery to collect this excess fee on behalf of the private health insurer. This arrangement is in the contract between the private health insurer and their client and is outside of the control of the cataract surgeon, their practice and the day surgery.
    • Some “Silver” health insurance do cover cataract surgery, whilst some “gold” health insurance policies do not. Even if you believe you have “top tier” or “blue ribbon” cover, it may not cover cataract surgery. This can be very disappointing for patients to learn they are not covered.
    • Whilst many cataract surgeons and their staff will attempt to ensure you are covered for private cataract surgery by your private health insurance, whether you actually are is determined by the contract between you and your private insurer and therefore it is up to you to determine that you are covered for cataract surgery.

    Out of pocket expenses

    • You will likely have some out of pocket expenses at the first consultation for tests not covered for by Medicare such as computerized topography, computerized tomography and or an OCT scan of your retina.
    • There may be a difference between the money Medicare gives you as a cataract patient and the amount the cataract surgeon charges for their assessment.
    • There may be a gap charged on top of private health insurance for the surgery (see above)
    • There may be an excess payable at the time of surgery to your private health insurer if you have insurance for cataract surgery.
    • There may be additional fees charged for particular lens types that are more complex such as multifocal lens implants

    Informed financial consent

    Prior to booking your cataract surgery, your cataract surgeon and practice staff should give you what is called “Full Informed Financial Consent” according to AMA guidelines, NSQHS recommendations and AHPRA legislation. This document provides the approximate costs, including out of pocket costs for every component of cataract surgery including:

    • Day hospital accommodation and theatre fees
    • Prostheses including lens implant and “Ophthalmic Viscoelastic Device”
    • Costs of any other prosthesis used
    • Cataract surgeon’s fee, health fund benefit if applicable and gap fee.
    • Anaesthetist’s fee, health fund benefit if applicable and gap fee.
    • Your agreed insurance excess if applicable
    • Hence the total out of pocket expenses you will need to pay on the day of your cataract surgery
    • Possible payment methods such as cash, credit card type accepted, etc.