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What if I need a knee reconstruction?

We explain how the public and private healthcare systems differ when it comes to waiting times, out-of-pockets and choice of surgeon for knee reconstructions.

A knee reconstruction is generally required following an injury to the anterior cruciate ligament — more commonly referred to as the ACL — and is the process in which this ligament is reconstructed or repaired.

If you’ve injured your ACL or feel your love of sports might be putting you at risk, it’s worth knowing the options when it comes to this common surgery, and understanding how your experience might differ in the public and private systems.

Jarrod and Jamie are both back playing the sports they love after serious knee injuries. One had surgery through the private system, the other through public. Watch their stories.

How long will I wait for surgery in each system?

How long you’ll wait in the public system will depend on what hospital you are treated in, however government data(1) shows that the average public wait for knee reconstruction surgery is 108 days, and can be more than 300 days in some cases.

In the private system, you can usually have surgery sooner. The main factors to consider are your own and your surgeons’ availability.

But remember, if you don’t have health insurance at the time of injuring your ACL, it is usually considered a pre-existing condition and you may have to serve a 12-month waiting period before you can claim benefits for the surgery.

Can I choose who performs the surgery?

With health insurance, you’ll be able to select the surgeon who’ll carry out your operation, which may help put you at ease if you’re feeling particularly nervous about the procedure. This is in contrast to the public system, where you will be assigned a surgeon. If you have health insurance, and you’re treated in a private hospital, you’re also more likely to have a private room for your recovery, depending on availability and clinical need.

What will my out-of-pocket expenses be?

Even though public patients may wait a while for knee reconstruction surgery, treatment in a public hospital means you will have little or no out-of-pocket expenses for your treatment.

If you go through the private system using your health insurance, your health insurer will pay benefits towards the cost of the procedure. However, you are likely to have some out-of-pocket costs depending on your excess, which hospital you are admitted to and how much your doctors charge.

It’s important to remember that every health insurance policy is different. If you want health insurance that pays benefits towards knee reconstructions, you should check it’s included in your cover.

(1) Data from Australian Institute of Health and Welfare, Waiting times for elective surgery in 2016–17,
Intended procedure tab showing median waiting days for anterior cruciate ligament reconstruction

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