What is the best insurance for weight loss surgery?

There are 2 kinds of private health insurance cover:

  1. Hospital cover for some (or all) of the costs of hospital treatment as a private patient

  2. General treatment (‘ancillary’ or ‘extras’) cover for some non-medical health services not covered by Medicare — such as dental, physiotherapy, optical

Some people with private health insurance have either hospital cover or extras cover, and some people have both.


Hospital insurance policies are classified as Gold, Silver, Bronze or Basic. It is optional for a health fund to offer weight loss surgery for Silver/Bronze/Basic. Weight loss surgery is included with Gold coverage and you can learn more here Product tiers (privatehealth.gov.au)


How do I check?

You will need to call the fund to confirm level of cover quoting the following Medicare items numbers which are the types of weight loss surgery offered by Toowoomba Weight Loss Surgery;

  • 31572 Gastric bypass by Roux-en-Y including associated anastomoses, with or without crucial repair taking 45 minutes or less, for a patient with clinically severe obesity not being associated with a service to which item 30515 applies (Anaes.) (Assist.)

  • 31575 Sleeve gastrectomy, with or without crural repair taking 45 minutes or less, for a patient with clinically severe obesity (Anaes.) (Assist.)

  • 31578 Gastroplasty (excluding by gastric plication), with or without crural repair taking 45 minutes or less, for a patient with clinically severe obesity (Anaes.) (Assist.)

Waiting period

The Government sets a 12 month maximum waiting period for existing conditions. Check with your insurer as it is likely this 12 month waiting period will apply.


Learn more at www.privatehealth.gov.au/

Private health insurance is also known as a health fund and there dozens to choose from in Australia. This Government website provides a tool to compare policies based on where you live and the cover you are looking for.


Will I still pay an Out of Pocket fee with health insurance?

Yes there will still be out of pocket fees in addition to the hospital costs covered by your health fund. See more detail here.


Will I still get a Medicare rebate?

Yes, the Government subsidises a portion of the cost of weight loss surgery which is paid as a Medicare rebate.

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