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How does health insurance cover spinal fusion?

All silver-tier health insurance policies must include spinal surgery, but we’ve found basic ones that’ll cover you from $18 a week.

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What you need to know

  • Spinal fusion is a major operation that can cost over $50,000 without insurance in the private system.
  • A spinal fusion can be covered by Medicare, or with private health insurance from around $18 a week.
  • The operation is very controversial, with critics calling is "expensive, dangerous and ineffective".

What is a spinal fusion?

Spinal fusion is surgery which permanently connects two or more vertebrae in your spine, thereby stopping motion between them and reducing pain. During the operation, your surgeon places bone (or a bone-like material) between the space in the two spinal vertebrae. Metal plates are often used to hold the vertebrae together, so they can heal as one solid structure. Spinal fusion surgery usually takes between 3 and 7 hours, using general anaesthetic the whole time. The typical hospital stay is between 2 and 7 days.

You might need spinal fusion for:

  • Spinal weaknesses. Your spine can become weak and unstable as a result of conditions such as severe arthritis in the spine or specific injuries.
  • Herniated disk. After the removal of a herniated disk, you might need a spinal fusion.
  • Spinal deformities. Spinal fusion is often used to treat spinal deformities such as scoliosis.

Spinal fusion controversy

Spinal fusions are controversial. Critics say there's little high-quality evidence that supports the use of the procedure for more back issues. Critics claim the treatment is expensive, often ineffective and that most back problems can be treated with less costly procedures. There is a lot of disagreement on this point, and the Medicare benefit for spinal fusions was almost amended in 2019 as a result. Be sure to do your own research before you make any major decisions.

How does Medicare and private health treat spinal fusions?

Public System

Medicare

In the public system, Medicare will cover the cost of medically necessary spinal surgery. You can find spinal surgery items within sub-group 17 (spinal surgery) of group T8 (surgical operations) on the Medical Benefits Schedule (MBS). Item numbers 51011 to 51171 cover various spinal surgery operations, including spinal fusions. Costs vary depending on the surgery and surgeon but for a rough guide, item number 51013 has a fee of $2,430.55.

In a private hospital, Medicare will cover 75% of the MBS fee, with you and your private health care provider paying the rest. Fees in the private sector tend to be significantly higher than the public system, however. See the section on the cost of spinal fusion treatment for details.

Private System

Private healthcare

You should be able to find cover for spinal fusion with all silver tier hospital policies under back, neck and spine. Silver-tier policies cost from around $25 a week. Most policies come with a 2-month waiting period, or 12-months if you have relevant pre-existing conditions.

Hospital treatment with private health insurance for back, neck and spine usually covers the investigation and treatment of the back, neck and spinal column, including spinal fusion. This includes sciatica, prolapsed or herniated disc, spinal disc replacement and spine curvature disorders such as scoliosis, kyphosis and lordosis.

Compare health insurance that covers spinal fusions

Here are a few policies from Finder partners that cover back, neck and spine in their treatments. All prices are based on a single individual with less than $90,000 income and living in Sydney.

1 - 10 of 74
Name Product Treatments Price Apply
Medibank Bronze Plus Progress
Bronze Plus$750 excess
  • Joint reconstructions
  • Ear nose and throat
  • Blood
  • Back neck and spine
  • Dental surgery
  • Eye excluding cataracts
  • Cancer
  • Lung and chest
  • +18 other treatments covered
$86.36
per month
Medibank Bronze Plus Progress
Bronze Plus$500 excess
  • Joint reconstructions
  • Ear nose and throat
  • Blood
  • Back neck and spine
  • Dental surgery
  • Eye excluding cataracts
  • Cancer
  • Lung and chest
  • +18 other treatments covered
$89.79
per month
lite bronze plus
Bronze Plus$750 excess
  • Joint reconstructions
  • Ear nose and throat
  • Blood
  • Back neck and spine
  • Dental surgery
  • Eye excluding cataracts
  • Cancer
  • Lung and chest
  • +14 other treatments covered
$91.94
per month
Medibank Bronze Plus Assured
Bronze Plus$750 excess
  • Joint reconstructions
  • Ear nose and throat
  • Blood
  • Back neck and spine
  • Dental surgery
  • Eye excluding cataracts
  • Cancer
  • Lung and chest
  • +20 other treatments covered
$93.98
per month
lite bronze plus
Bronze Plus$500 excess
  • Joint reconstructions
  • Ear nose and throat
  • Blood
  • Back neck and spine
  • Dental surgery
  • Eye excluding cataracts
  • Cancer
  • Lung and chest
  • +14 other treatments covered
$96.77
per month
Medibank Bronze Plus Assured
Bronze Plus$500 excess
  • Joint reconstructions
  • Ear nose and throat
  • Blood
  • Back neck and spine
  • Dental surgery
  • Eye excluding cataracts
  • Cancer
  • Lung and chest
  • +20 other treatments covered
$99.97
per month
Medibank Bronze Plus Progress
Bronze Plus$250 excess
  • Joint reconstructions
  • Ear nose and throat
  • Blood
  • Back neck and spine
  • Dental surgery
  • Eye excluding cataracts
  • Cancer
  • Lung and chest
  • +18 other treatments covered
$100.42
per month
core bronze plus
Bronze Plus$750 excess
  • Joint reconstructions
  • Ear nose and throat
  • Blood
  • Back neck and spine
  • Dental surgery
  • Eye excluding cataracts
  • Cancer
  • Lung and chest
  • +17 other treatments covered
$102.19
per month
core bronze plus
Bronze Plus$500 excess
  • Joint reconstructions
  • Ear nose and throat
  • Blood
  • Back neck and spine
  • Dental surgery
  • Eye excluding cataracts
  • Cancer
  • Lung and chest
  • +17 other treatments covered
$107.51
per month
HCF HOSPITAL STANDARD SILVER PLUS
Silver Plus$750 excess
  • Lung and chest
  • Back neck and spine
  • Cataracts
  • Joint replacements
  • Blood
  • Dental surgery
  • Palliative care
  • Pregnancy and birth
  • +24 other treatments covered
$108.26
per month
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Compare up to 4 providers

How much does spinal fusion surgery cost?

Spinal fusion in the private system without insurance costs from $25,000 to $58,000+. Surgeon's fees tend to be the main expense (from $14k to $35k+) but costs like hospital admission and anaesthetists also contribute. Here are some of the estimates we were able to find:

SourceCostNotes
Medibank$42,226Medibank's cost estimation comes from claims data from partner hospitals. It doesn't include additional out-patient costs.
HCF$24,219 - $48,458HCF's cost estimate varies based on a range of gap options and whether a partner hospital is used.

Other things to know if you need a spinal fusion

Before you agree to any complex procedure, make sure your health provider will cover you. Ask them about potential out-of-pocket expenses, such as consultation and anaesthesia fees. Be sure to ask for the MBS item number from the surgeon as well. That way, you'll have a good idea of any out-of-pocket expenses.

Before surgery

If you choose to go private, it's likely your health fund will have a No Gap scheme. Always ask the surgeon you use if they are participating in the scheme; this will keep out-of-pocket expenses to a minimum. Doctors' fees can vary significantly so it's smart to ask them about their fees before commencing treatment.

Because spinal fusion is a complex procedure, you may encounter out-of-pocket costs for an orthopaedic surgeon, specialist consultations, assistant surgeon, anaesthetist, pathologist and radiologist. Ask your health insurance provider about costs for these services before surgery.

After surgery

You will probably need rehabilitation after spinal surgery and your activities should be limited for the first 6 months. Every surgeon will have slightly different post-op care to adhere to so be sure to follow your surgeon's advice. You shouldn't bend past 90 degrees, lift anything heavy at all and avoid twisting your back as much as possible. Physiotherapy is often an important part of the recovery process as well. You won't be allowed to drive for at least 6 weeks after surgery.

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