No Out-of-Pocket Program

Many orthopaedic practices advertise a "no-gap" service. What they mean is that the surgeon charges no gap — they accept the health fund benefit as full payment for their own fee. That is a meaningful concession, but it is not the same as no out-of-pocket costs for the patient.

A patient undergoing surgery typically incurs fees from multiple providers: the surgeon, the anaesthetist, the hospital, and post-operative rehabilitation. In most "no-gap" arrangements, only the surgeon's gap is waived. The anaesthetist's gap, the hospital excess, and private rehabilitation costs remain the patient's responsibility — often amounting to several thousand dollars.

The No Out-of-Pocket Program is different. It is a coordinated pathway in which every component of eligible care — surgery, anaesthesia, hospital, and rehabilitation — is covered by the health fund benefit, with zero residual cost to the patient.

Central to the program is a rapid at-home rehabilitation model, developed as part of an integrated care pathway. Rather than spending days or weeks in a private rehabilitation facility — which is expensive for health funds and often inconvenient for patients — eligible patients are discharged with a structured home rehabilitation program, supported by allied health professionals.

The cost savings this generates for health funds are substantial. Those savings enable the fund to waive the patient's remaining gap across all providers, resulting in a truly zero-cost surgical episode for the patient.

The program was developed as part of an integrated orthopaedic care model led by Prof Munjed Al Muderis and is available to eligible patients across approved facilities.

The program is available to patients who hold an eligible private health insurance policy with an approved fund and who have completed the required waiting periods for their procedure. Not all procedures or all funds qualify. Our team will confirm your eligibility during your consultation.

Please bring your health fund details — including your fund name, membership number, and level of cover — to your first appointment. We will confirm eligibility and provide a clear breakdown of any costs before you proceed.