Does my health insurance cover sinus surgery? 

Has your doctor recommended sinus surgery, or another nasal procedure such as septoplasty or turbinate reduction? All of these ear, nose and throat (ENT) surgeries are subject to long waiting times in the public hospital system in Australia. If breathing problems, recurring sinus issues and sleeping problems are having a serious impact on your life, you might consider opting for private hospital treatment. So can you use private health insurance for sinus surgery? Yes, but it depends on the type of cover you have. Here’s what you need to know.  

Is sinus surgery covered on Hospital Cover? 

Yes, sinus surgery and many types of nasal surgery fall under the Ear, Nose and Throat clinical category of Hospital Cover, which is compulsory for insurers to include on Bronze tier policies and above. This includes: 

• septoplasty – to straighten a deviated septum  

• turbinate reduction – to repair enlarged turbinates (the bony structures in nasal passages) 

• functional endoscopic sinus surgery (FESS) – to remove sinus blockages.  

However tonsillectomy, adenoidectomy and grommets are covered under their own clinical category, and rhinoplasty for medical reasons (not cosmetic) is under Plastic and Reconstructive Surgery, so check your policy carefully to see what clinical categories are included. 

What do the different tiers of Hospital Cover include?

Remember that appointments to see ear, nose and throat surgeons to discuss your procedure won’t be covered, as Hospital Cover only applies to treatments that happen in hospital. Consultations will qualify for a Medicare subsidy, but you’ll have to pay the rest of the surgeon’s fee out of pocket.  

How much does sinus surgery cost in Australia? 

The cost of sinus surgery depends on the type of surgery, complexity and the fees charged by the doctors involved. According to Medical Costs Finder, septoplasty averages $2,500 with a typical Medical Gap of $650, while sinus surgery averages $2,800, with Aussies paying an average Gap of $670. 

Make sure you get a breakdown of costs from your surgeon, including fees for all surgeons involved (e.g. anaesthetists) and any hospital fees (which won’t apply if you go to a public hospital). You can lower your out-of-pocket costs by choosing a surgeon who has a no-Gap or known-Gap agreement with your insurer, and a hospital that has an Agreement Hospital arrangement with your insurer, which would mean you’ll have either no out-of-pocket costs for hospital fees or a lower Hospital Gap. 

Why do I have to pay a Gap?

How much does health insurance for sinus surgery cost? 

Using the healthslips.com.au Calculator, we searched for the cheapest Hospital Cover policy that included Ear, Nose and Throat cover for one adult in Victoria. We found a Basic Plus policy for $127.61 a month, with a $750 excess. 

Remember a waiting period of at least 2 months will apply before you can claim. If your condition is considered pre-existing – which means you had symptoms in the 6 months before you bought the policy, the waiting period will be 12 months.  

If your health insurance policy doesn’t offer the level of ear, nose and throat surgery cover you’d like, compare it with all similar policies using the healthslips.com.au Calculator, or look for a new policy that fits your budget. Unlike other health insurance comparison websites, we compare every policy in Australia without any commercial bias, and you don’t have to enter your contact details to get your results.  

How do I use the healthslips.com.au Calculator to find the right health insurance?

healthslips.com.au does not provide general or personalised advice. Your particular circumstances are likely to impact the accuracy, completeness and relevance of the information or results. Take this into account before making a decision and talk to an expert for financial advice.

Trudie McConnochie

Writer and Researcher

Knowledge is power – that’s the guiding principle behind everything Trudie writes, and it’s a philosophy she brings to her work at healthslips.com.au. By breaking down complex information into easy-to-understand blogs and stories, she aims to empower Australians to make the best choices and an informed decision around private health insurance.

Trudie understands firsthand some of the complexity of private health insurance having moved to Australia from New Zealand and having to navigate a vastly different public healthcare system and health insurance structure.

Trudie holds a Bachelor of Communication Studies (journalism major) from the Auckland University of Technology.

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