Spinal fusion surgery cost

Due to it being a major surgery, any spinal surgery typically won’t be recommended by your medical professional until other treatments have been tried.

Spinal fusion could potentially help solve issues such as:^1,2,3,4,5

• Back pain
• Compressed spine
• Scoliosis
• Herniated disk
• Degenerative spinal disorders or deformities
• Spinal stenosis
• Spinal weakness
• Issues with bones, joints or discs in your spine.

It’s important to be aware that while most patients experience some benefit or relief from spinal surgery, it may be ineffective for some people.

While spinal surgery can help treat lower back pain and instability caused by cancer, infection, neural compression or previous surgery, there is debate over whether it is the right choice for most back pain issues.^6,7

There is a lack of high-quality data to justify spinal fusion over non-surgical measures in many cases, especially the risks of major surgery. Before committing to having a major surgery, talk to your doctor about the best course of action for your situation.

Spinal fusion surgery isn’t going to be the right solution for all back pain and in some cases, the risks could outweigh the potential benefits.^6,7Back and neck pain are common issues and there are a range of potential treatments your specialist or doctor may recommend as an alternative to spinal fusion surgery:

• Physiotherapy
• Chiropractic
• Exercise
• Pain relief medications and anti-inflammatory medications (these won’t address the cause of your condition but can minimise pain and discomfort)
• Steroid injections.

Some serious issues may need immediate spinal surgery. However, in most cases, your doctor will try some of the treatments listed above before resorting to spinal surgery. For many back issues, symptoms are unlikely to get worse quickly, so it could be worth trying other options. Extras health insurance can contribute towards many of these health services, including physiotherapy and chiropractic.

Surgery costs for medically necessary spinal fusion surgery can be included under the clinical category ‘back, neck and spine’, which is a minimum requirement for Silver-tier hospital cover.⁸

You’ll likely try a few treatments before undertaking spinal surgery, so it may be worth purchasing a policy that also includes these. Extras cover can provide coverage for a range of services, including physiotherapy and chiropractic care, depending on your inclusions.

There are several benefits to being treated as a private patient in a private hospital, including:

• Avoiding public hospital waiting lists
• A choice of specialist and clinic
• More flexibility over when your procedure will happen
• Private room (subject to availability).

There may be a ‘gap’ between the MBS fee and what your specialist charges. Your health fund may or may not cover this gap payment, depending on your policy. When considering private health insurance, it is important read the Product Disclosure Statement (PDS) and the Target Market Determination (TMD), to understand what is covered and ensure the policy is suitable.

Medicare can cover the costs of medically necessary spinal surgery as a public patient in a public hospital. Medicare can also contribute towards the costs of various spinal surgeries in private clinics, covering 75% of your MBS fee. The remaining 25% will be covered by your health fund or as an out-of-pocket cost if you aren’t insured for the procedure.

Unfortunately, the public health system is in demand which can mean long wait times for elective surgeries. This means you could potentially wait weeks or months until you receive treatment.⁹

When purchasing health insurance or upgrading your cover, it’s important to be aware of waiting periods. Before making a claim, you’ll need to wait a certain amount of time from when your policy begins. For most procedures, the waiting period will be two months. If the procedure is for a pre-existing condition (something you had before you purchased insurance), then the waiting period will typically be 12 months. There are some exceptions to these rules, which are standard across all health funds.