Fees & out-of-pocket costs
Dr Mooney’s fees are based on those recommended by the Australian Medical Association. We believe in being transparent about fees.
Why out-of-pocket costs exist
Dr Mooney’s surgical fees are based on the rates recommended by the Australian Medical Association (AMA), the national body that assesses the real cost of running a safe private practice and recommends fair and reasonable fees to surgeons.
The Medicare rebate for surgical procedures was frozen for several years. Indexation was only reintroduced for specialist procedures from 1 July 2019, and it has not caught up with what it costs to provide surgical care. The rebate fell behind. Theatre time, implants, indemnity insurance and staffing did not.
Even with top-level private hospital cover, Medicare and your health fund will typically cover only part of the surgical fee. The remainder, the gap, is your out-of-pocket cost. This is not unique to Dr Mooney’s practice: it affects private orthopaedic surgeons across Australia.
How fees are structured
Most orthopaedic consultations and procedures attract a Medicare rebate. A valid GP referral is required to claim it. Without a referral, you will receive no Medicare contribution.
Private health insuranceIf you have private health insurance with hospital cover, your fund will contribute toward the cost of your hospital stay, theatre fees, and anaesthetist fees. Your policy’s excess and any gap payments will affect your final out-of-pocket cost.
The surgical fee gapThe gap between the AMA-recommended surgical fee and the Medicare plus health fund rebate is the amount you pay out of pocket. This varies between procedures and between funds. For worked examples see knee arthroscopy and meniscus surgery costs and knee replacement costs.
Other costsIn addition to the surgical fee, a hip or knee operation involves separate fees from the anaesthetist, the hospital (theatre, ward stay, implants), and any post-operative imaging. These are billed and rebated separately from Dr Mooney’s fee.
What to expect financially
After your surgical procedure is booked, Dr Mooney’s team will issue a financial consent document. This sets out the full surgical fee, the expected Medicare and health fund rebates, and your estimated out-of-pocket cost, clearly and in writing, before anything proceeds.
The full surgical fee is payable before your operation. After your procedure, your Medicare rebate and any private health fund rebate are processed and paid directly back to you by Medicare and your insurer. Dr Mooney’s practice does not claim from Medicare or your health fund on your behalf.
If you have any questions about fees at any point, please call the rooms. (08) 7077 0157
Consultation fees
A Medicare rebate applies to consultations where a valid GP referral is held.
| Consultation type | Standard fee | Aged Pension fee |
|---|---|---|
| Initial consultation | $220 | $200 |
| Review consultation | $130 | $110 |
Aged Pension rate applies to Centrelink Aged Pension card holders. Please advise the rooms at time of booking.
Second opinion consultationsSecond opinion consultations are charged at $550 for the initial assessment, reflecting the additional work involved in collating prior imaging, operative reports, and clinical history. Dr Mooney does not see second opinion requests for WorkCover or third-party claims.
Health fund participation
HCF members: gap free hip and knee replacement. Dr Mooney is a participating surgeon in HCF’s No-Gap Joints Program at Eastwood Private Hospital, the only South Australian hospital taking part. Eligible HCF members having a primary hip or knee replacement there have no out-of-pocket cost for the surgeon, the anaesthetist or the hospital admission. Your hospital excess still applies, and consultations in the rooms are charged as usual. Full details and eligibility
Dr Mooney does not participate in known-gap schemes. However, a small number of other private health funds contribute at the full AMA rate for surgical procedures. Where this applies, Dr Mooney bills the fund directly, meaning no out-of-pocket cost to the patient.
Due to confidentiality obligations, Dr Mooney’s rooms are unable to publish a list of those other participating funds. To find out whether your fund qualifies, call the rooms with your health fund details before your procedure. (08) 7077 0157
Frequently asked questions
A valid GP referral is required to claim the Medicare rebate on your consultation and any subsequent procedure. Without a referral, you will pay the full fee with no Medicare contribution. Your GP can refer you based on symptoms alone.
You can still be seen and treated by Dr Mooney without private health insurance. You will be responsible for the full out-of-pocket cost of any procedure, as health fund rebates will not apply. Call the rooms to discuss options.
Dr Mooney operates primarily in the private system. For public patients requiring hip or knee surgery in Adelaide, referral to a public waiting list at a public hospital is the appropriate pathway. Your GP can advise on this.
Call Dr Mooney's rooms with your health fund details and the procedure being considered. We can provide a written estimate once your procedure is confirmed. You can also call your health fund directly: they can advise on their rebate for a specific MBS item number, which the rooms can provide.
Gap free hip and knee replacement for HCF members
Eastwood Private Hospital is the only South Australian hospital in HCF’s No-Gap Joints Program. Eligible members pay no out-of-pocket surgeon, anaesthetist or hospital costs.
Questions about fees?
Call the rooms or submit an online enquiry. The team is experienced at walking patients through their costs.
The information on this page is provided as general information only and does not constitute medical advice. Individual circumstances vary. Please consult Dr Mooney or your GP to discuss your specific situation.