Weight Loss Surgery Australia – All You Need to Know

This following section will cover all the cost, insurance, and financing information you’ll need to make an informed decision about weight loss surgery in Australia.

Your Total Out of Pocket Costs with or without Private Insurance

Your total out of pocket costs will likely fall in the following ranges:

• With Private Insurance: $2,800 – $7,000 after Medicare rebates
• Without Private Insurance: $12,000 – $18,000 after Medicare rebates

The final amount will depend on a number of factors, including:

• Initial surgeon consultation fees (between $100 and $200, a portion for which you can claim a Medicare rebate)
• Type of surgery chosen
• Surgeon’s fees
• Surgical Assistant fees
• Hospital fees
• Anaesthetist’s fees
• Medications prescribed after surgery

Following are surgery-specific ranges currently charged throughout Australia:

• Gastric band surgery cost Australia (Lap-Band):
  • With private insurance: $2,500 to $5,500 not including Medicare rebates
  • Without private insurance: $10,000 to $16,000 not including Medicare rebates
• Gastric bypass surgery cost Australia:
  • With private insurance: $4,000 to $6,000 not including Medicare rebates
  • Without private insurance: $16,000 to $18,000 not including Medicare rebates
• Gastric sleeve surgery cost Australia:
  • With private insurance: $4,000 to $6,000 not including Medicare rebates
  • Without private insurance: $16,000 to $18,000 not including Medicare rebates
• Gastric balloon cost Australia:
  • Without private insurance: $5,825 average (insurance typically will not cover the procedure but may cover the gastroscopy [the upper GI tract exam using an endoscope])

Talk with a local qualified surgeon for a more detailed quote. Be sure to ask whether there will be an added charge if additional procedures are required during your surgery.

Private Insurance for Bariatric Surgery in Australia

Private insurance in Australia usually covers bariatric surgery, although you will still have out of pocket fees over and above what the insurance companies cover (between $1,700 and $5,300 after Medicare rebates).

Use the following interactive tool to see the average out of pocket costs for gastric bypass, gastric banding (Lap-Band), and gastric sleeve surgery in your state/territory…

(NOTE: All territories with data are classified as "low cost" because compared to other countries like the United States, most patients have private insurance and therefore pay much lower out of pocket costs)

Since obesity is considered a pre-existing condition, you will probably have to wait 12 months between joining a health fund and getting approved for surgery.

Note that many surgeons will not perform any surgery other than gastric banding (Lap-Band) if you do not have private insurance.

To get the specific coverage information and your out of pocket costs from your health fund, contact them directly and provide the following Medicare item numbers:

• Gastric banding – Item 31569
• Gastric bypass – Item 31572
• Gastric sleeve (sleeve gastrectomy) – Item 31575
• Duodenal switch – Item 31581
• Reversal of Gastric Banding/Lap-Band (removal or replacement of gastric band) – Item 31584
• Intragastric balloon – There is no item number specifically for the balloon, but you can provide the number for gastroscopy since they may pay for that portion of the treatment – Item 30473

Click here for a full list of Australian health funds and their contact information.

You can also contact your local qualified surgeon for help understanding total costs and how insurance will apply.

Medicare Reimbursement

Medicare will provide some reimbursement for the procedures listed below, although the rebate amount will still leave the majority of costs up to you and your private insurance.

To determine your rebate amount, Medicare applies a set rate to each covered procedure (that is much lower than the actual surgery costs), then they give you a rebate of 75% of that set rate.

Click here to access the Medicare Benefits Schedule (MBS) database and type in the following Item Numbers for current reimbursement levels for each procedure:

• Gastric banding – Medicare Benefits Schedule – Item 31569
• Gastric bypass – Medicare Benefits Schedule – Item 31572
• Gastric sleeve (sleeve gastrectomy) – Medicare Benefits Schedule – Item 31575
• Duodenal switch – Medicare Benefits Schedule – Item 31581
• Reversal of Gastric Banding/Lap-Band (removal or replacement of gastric band) – Medicare Benefits Schedule – Item 31584

If you need help determining Medicare rebate amounts, talk with your local surgeon.

Accessing Superannuation Benefits for Weight Loss Surgery Australia

The Department of Human Services (DHS) will consider the early release of your superannuation funds on what they call "specified compassionate grounds" for a medical treatment that:

1. Treats a life-threatening illness
2. Alleviates acute or chronic pain

Obesity may fall under one or both of these categories. And since weight loss surgery is recognized as an effective medical treatment for obesity, the DHS may agree to an early release of your funds to help with your surgery payment.

Click here to go to the DHS website for more information.

Personal Finance Bariatric Surgery Australia

Financing is usually available for bariatric surgery in Australia either directly through your surgeon (payment plan) or through a third party lender.

The most commonly recommended third party lender in Australia is Mac Credit. Their plan maximums easily cover all of the costs associated with any weight loss surgery procedure, and their policy is to process all applications within 24 hours of receiving all requested information. Click here to submit an online application.

GE’s CareCredit Australia used to be recommended by surgeons (and is still listed on some practices’ websites) but it is no longer an option. GE’s CareCredit Australia website suggests using Gem Visa’s interest free credit card instead. Click here to learn more.

For other ideas, see our Financing Bariatric Surgery page.

Tax Offset for Weight Loss Surgery Australia

If your out of pocket expenses for bariatric surgery (and all other net medical expenses) are over the Australian Taxation Office (ATO) threshold, you can claim an offset on your tax return.

According to the ATO…

“To claim the net medical expenses tax offset in your tax return, you will need to know the total medical expenses you incurred for yourself and your dependants. You then deduct any refunds from Medicare, your health fund or any other reimbursements that relate to those expenses received during the financial year.”

Click here for updated Medicare Benefit Tax Statement information from the Department of Human Services.