Appendectomy Surgery Costs

What is the standard treatment for appendicitis?

Appendicitis surgery is called an appendectomy. The procedure is an operation, performed in a hospital, where the surgeon removes your appendix.

What is an appendectomy?

There are two common types of appendix removal procedures, depending on the severity of your appendicitis:

• Open Appendectomy: This procedure involves making a single incision through the skin, underlying tissue, and abdominal wall to access the appendix.

• Laparoscopic ('Keyhole') Appendectomy: This method involves making three small incisions in the abdomen. Special instruments are inserted through these incisions, and gas is gently pumped into the abdominal cavity to separate the abdominal wall from the organs. This separation allows for easier examination of your appendix and internal organs.

A laparoscopic appendectomy will allow you to recover faster with fewer scars. 

How much does a laparoscopic appendectomy cost?

A laparoscopic procedure usually costs less than an open appendectomy. However, if the appendix has ruptured and infection has spread, you may have to undergo an open appendectomy so that your surgeon can thoroughly cleanse your abdominal cavity of any infectious material.

Both surgeries are covered under the hernia and appendix clinical category, which is included in a Bronze hospital insurance policy or some Basic Plus policies.

Appendectomies are typically carried out on an emergency basis, meaning you can be taken to the nearest public hospital emergency room and treated free of charge, if necessary.

In this case, Medicare covers the entire appendectomy cost without insurance. However, if you choose to be treated as a private patient in a public hospital or be transferred to a private hospital, Medicare only covers 75% of the Medicare Schedule Fee your doctors services, with private hospital insurance covering the remaining 25% and some or all of your hospital and remaining medical costs.

Important Note: Private doctors and surgeons may charge above the Medicare Benefits Schedule (MBS) fee, leading to out-of-pocket costs known as gap payments. Without private health insurance, your cost of appendectomy can be in the thousands, if you’re treated at a private hospital.

Will I have to pay out of pocket costs even if I have private health insurance?

When you undergo your appendectomy privately, you have the option to choose your own doctor and recover in a private room if available.

In 2021-22, 78.6% of all privately treated patients with minor complexity appendectomies owed a gap payment, with the average gap paid being $619. Depending on your policy, you may also need to pay an excess or a co-payment.

Your approximate costs could look like:

Total procedure cost: $6,887

Insurer pays: $5,458

Medicare pays: $367

Excess (you pay): $0-750

Out-of-pocket (you pay): $312

Out-of-pockets for this procedure typically don’t exceed $1,000. 

The amount of excess to be paid out of your pocket depends on your policy and this amount typically varies from $0 - $750. Some insurance policies may also have a per-day payment arrangement for your hospital stay.

Will I have to pay an excess to my health fund?

Depending on your health fund and the hospital you’re recovering in, you may face an out-of-pocket co-payment for each day you remain in hospital. It’s also likely that you’ll have to pay an excess on admittance to hospital.

What does an appendectomy cost without insurance?

Without hospital insurance, the average cost for an appendectomy of minor complexity was $6,887 in the 2021-2022 period. 

This cost encompasses: 

• the surgery itself, 

• doctors' fees, 

• theatre fees, 

• anesthesiologist fees, and

• other related hospital expenses incurred during your hospital stay.

However, it's important to note that this is just an average figure and may not reflect the actual cost. The price of your appendectomy can vary significantly based on your state, the medical professionals involved, and the presence of any surgical complications.

For example, in most Australian states and territories (excluding Queensland and Tasmania), ambulance transportation incurs a fee. Private health insurance can help you cover these costs, which can be substantial without insurance - especially as most appendectomies are brought to hospital as emergencies and this usually involves an ambulance ride.

What level of hospital cover do I need for an appendectomy?

To claim treatment for appendicitis, you typically need at least a Bronze hospital insurance policy, which covers hernia and appendix procedures. 

Your health insurance can help cover: 

• surgeon fees, 

• anaesthetist fees, 

• operating theatre costs, 

• accommodation, 

• prescriptions, and more. 

Depending on your hospital and doctors' agreements with your health fund, you may have no or reduced out-of-pocket costs.

You'll need to serve a 2-month waiting period before claiming on appendix surgery with private health insurance. Pre-existing conditions may require a 12-month waiting period. Without insurance, the average cost for an appendectomy with minor complexity was $6,887 in 2021-22. Private health insurance can also help cover ambulance fees and excess or co-payments during your hospital stay.

What are the median appendectomy costs by country?

According to the 2022 report from the Health Cost Institute (2022) for an appendectomy without complications, with overnight hospital admission, resection of appendix, percutaneous endoscopic approach inpatient, These figures represent median costs of this procedure.

Note that the number of hospital days covered by insurers ranges from 6 days to 1.5 days. 

The cost of appendicitis surgery can be significant, but with the right hospital insurance policy, you can reduce your out-of-pocket expenses and ensure you receive the care you need in a timely manner. It's important to understand your insurance cover, waiting periods, and any potential costs before undergoing appendectomy surgery.

Sources:

Healthdirect, Department of Health, Australian Government.

Betterhealth Victoria: Appendectomy.

Hospital Casemix Protocol: Annual Report. Department of Health, Australian Government. 2021-22.

https://pubmed.ncbi.nlm.nih.gov/2239906/#:~:text=A%20life %20table%20model%20suggests,males%20and%2023.1%25% 20for%20females.

https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=30720&qt=ItemID

https://www.medibank.com.au/health-support/hospital-assist/costs/appendicectomy/

https://www.safetyandquality.gov.au/sites/default/files/migrated/4.5-Appendicectomy.pdf

https://www.aihw.gov.au/getmedia/1fc59c7b-1fdb-4bbc-862c-99beaa2c73c0/hp_costsofacuteadmittedpatients_2011_12_rpt.pdf.aspx?inline=true

https://healthcostinstitute.org/images/pdfs/international_health_cost_comparison_report_2022.pdf

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This guide is opinion only and should not be taken as medical or financial advice. Check with a financial professional before making any decisions.

Chris Stanley is the sales & operations manager of health insurance at Compare Club. With extensive experience and expertise, Chris is a trusted leader known for his deep understanding of health insurance markets, policies, and coverage options. As the sales & operations manager of health insurance, Chris leads a team of dedicated professionals committed to helping individuals and families make informed decisions about their health insurance needs.

Meet our health insurance expert, Chris Stanley

Chris's top health insurance tips

• 1

  Australia’s public health system is world-class, but wait times for public hospitals can be long, inconvenient - and leave you living in constant pain while you wait.

• 2

  An appropriate private health insurance policy can speed up your surgery, relieving your pain sooner.

• 3

  Family health cover means your children are covered under the same policy as you.

• 4

  Many health insurance policies come with a 12-month waiting period for pregnancy-related cover, so it’s a good idea to get a family policy organized well before starting your family. This means your child will be covered from birth until at least their early twenties (depending on which health fund you select).