Surgically Implanted Prosthesis

The Department of Health produces a list of approved prostheses showing what benefit health funds should pay for each prosthesis. Most government-approved surgically implanted prostheses are fully covered by your hospital cover. However, some will require a patient contribution or out-of-pocket cost to be paid if the supplier charges above the listed benefits.

If you require surgery that involves a surgically implanted prosthesis, you should check with your surgeon to see if a patient gap applies to the prosthesis being used. If the prosthesis is not fully covered, ask your surgeon if there is an appropriate no-gap option. If a prosthesis that has a patient gap is to be used, your surgeon should obtain your informed financial consent and advise you prior to the surgery of the amount of gap you will be required to pay. Please contact Astute Simplicity Health prior to surgery to confirm your benefit entitlement.