Key Takeaways
- Choosing your own surgeon gives you more control over your experience in the hospital, including who actually does your surgery and where it takes place.
- Having private hospital cover means you can bypass long public waitlists and get treatment sooner with your preferred specialist.
- Health insurance policies are very varied – so comparing your options and getting expert advice means your policy will give you the freedom and flexibility you need.
Private health insurance means you can pick your own surgeon
Not sure whether it’s actually worth it to pay for private health insurance?
Here’s a question that might help you make a decision: if you had to undergo serious surgery in the near future, would you be happy with any available specialist that was assigned to you, or would you prefer to have the choice to pick your own surgeon?
If you are leaning towards the latter, then you’ll want to make sure you have private health insurance. Aside from not being stuck with the long wait times in public hospitals, you can also be in charge of who does your surgery and whether it happens in a public or private facility.
Public hospital vs private hospital: Who chooses your doctor?
If you’re being treated in the public system, you’ll usually be assigned a surgeon by the hospital. Even if you’re referred by your GP to a specialist, there’s no guarantee they’ll be the one who operates on you. Public hospitals are under constant pressure to manage large volumes of patients, and who you see depends on availability and the hospital’s internal roster.
In contrast, if you have private hospital cover, you have the power to choose your own specialist – and stick with them throughout the process. You can consult with a surgeon of your choice, check on their experience and background, and know exactly who will be performing your procedure. That continuity of care can give you total reassurance, especially for more serious or life-altering operations.
The right surgeon can make a big difference
Surgical outcomes depend on the complexity of your condition and your overall health. But it’s also true that experience and communication style matter too. When you choose your own surgeon, you can:
- Review their experience with your specific procedure.
- Ask them questions and determine how well they explain things.
- Look at other patients’ reviews or referrals.
- Get a second opinion if needed.
Having such agency means you can feel more confident not just in the surgery itself, but in your specialist’s approach, bedside manner and follow-up care. You can also choose a surgeon whose practice location and appointment schedule work for your needs.
Speedy surgery – on your own terms
One of the biggest frustrations with the public system is the waiting time. Many non-urgent procedures are subject to long delays – sometimes months or even years, depending on your condition and where you live. Elective surgeries like joint replacements, cataract removal or hernia repair are often pushed back due to demand and triage protocols.
When you have private hospital cover, you can:
- Book in with your preferred surgeon directly.
- Schedule your surgery sooner.
- Not have to worry about ongoing pain or worsening symptoms while waiting.
That means faster relief and less disruption to your daily life. And in many cases, early intervention means better recovery and fewer complications.
Portability
Don’t re-serve waiting periods when you switch to a new health fund or policy
“John was immediately covered for a hip replacement in private hospital because he had already served his waiting periods for joint replacements on his old policy”
Continuity of care and treatment
Being able to choose your own surgeon often means better continuity of care. In the public system, it’s common to see multiple doctors throughout your treatment journey – one for consultation, another for the operation and a different one again for follow-up.
With private hospital cover, your chosen surgeon will manage your care from start to finish, which gives you a more personalised experience. You’re not repeating your story every time you meet a new face, and your surgeon is more familiar with your individual medical history and any concerns you might have.
This kind of consistent, patient-centred care can make a big difference to how comfortable and supported you feel throughout the entire surgical journey.
How private health insurance supports this choice
To choose your own surgeon and take advantage of the private system, you’ll need an appropriate level of hospital cover. Most Bronze Plus, Silver and Gold hospital policies will include cover for a wide selection of procedures and conditions, but you’ll want to check that the specific surgery you need is included. Here’s what to keep in mind:
- No lock-in contracts: You can switch funds at any time if another insurer has a better policy for your needs.
- Waiting periods are preserved: If you’ve already served your waiting periods for surgery, you won’t need to re-serve them when switching to an equivalent or lower-level policy.
- Pre-paid premiums are refunded: If you change funds after paying ahead, your old insurer will refund the unused portion.
Make sure you check that your preferred surgeon works at a hospital that is contracted with your insurer. Otherwise you might be on the hook for high out-of-pocket costs for accommodation and theatre fees.
The reality of out-of-pocket costs
It’s important to know that choosing your own surgeon doesn’t necessarily mean zero costs. While Medicare and your health insurer will jointly cover the scheduled fee for hospital procedures, a lot of specialists charge more than the Medicare Benefit Schedule (MBS) allows. This is where out-of-pocket costs can crop up.
Most private health funds have medical gap cover to help keep these expenses to a minimum. Surgeons who participate in your fund’s gap scheme can charge either:
- No gap: You pay nothing extra.
- Known gap: You pay a capped amount, which must be disclosed upfront.
Always ask your surgeon for a written quote before proceeding and confirm whether they participate in your fund’s gap scheme. That way, there are no unwelcome surprises.
Summary
So, is it worth it? If you want to be in control of things like choice of surgeon and faster treatment, then being able to choose your own surgeon through private health insurance makes the answer an obvious ‘yes’. It’s true, there might still be some out-of-pocket costs, but the advantages of having control over your care team and not having to deal with long delays – especially if you’re dealing with chronic pain or mobility issues – could be the clincher.
At Fair Health Care Alliance, we help Australians compare hospital cover policies to make sure they get the cover they need – without overpaying. Whether you’re planning a procedure soon or just want to be prepared, the right policy can give you both peace of mind and the flexibility to choose who looks after your health.
FAQ's
Yes – so long as the surgeon operates at a hospital contracted with your insurer and the procedure is included in your policy.
Yes, if you’ve already served your waiting period then it will carry over to your new fund as long as your cover is at the same level or lower.
Ask your insurer for a list of participating specialists or check with the surgeon’s clinic before proceeding with care.
