Can I claim health insurance for back pain treatments? 

Back pain can be debilitating, and it’s an issue experienced by around 4 million Australians, according to data from the Australian Institute of Health and Welfare. Sometimes back pain is treated with surgery, such as spinal fusion or spinal disc replacement, but in many other cases a combination of less intensive treatments are recommended. Here’s how you can use health insurance for back pain treatments. 

Is spinal surgery covered by health insurance?

Yes. Spinal surgery is covered by Medicare if you’re treated in a public hospital, and if you choose to be treated as a private patient you can be treated faster and claim on your health insurance. If you have Hospital Cover that includes the Back, Neck and Spine clinical category, you’re covered for spinal surgeries including spinal fusion, spinal disc replacement, prolapsed or herniated disc treatment, and spine curvature procedures (e.g. for scoliosis). You should know, however, that spinal surgery is contentious – according to a University of Sydney report, there can be serious complications following spinal fusion surgery, and it’s not more effective than non-surgical approaches. 

What are the different tiers of Hospital Cover and what does each include?

How much does spinal surgery cost in Australia? 

The spinal fusion surgery cost in Australia is around $58,000 – making it the most expensive orthopaedic procedure in Australia. That means if you decide to go private, you’re looking at large out-of-pocket costs, as surgeon costs tend to be high. According to data from government regulator APRA (Australian Prudential Regulation Authority), orthopaedic procedures involved the largest out-of-pocket payment in the April to June 2025 quarter, with an average Gap of $789.69.  

Why do I have to pay a Gap for hospital treatment under health insurance?

How much is health insurance for spinal surgery? 

Back, Neck and Spine cover is included in some Basic and Bronze Hospital Cover policies but may be restricted – which means large out-of-pocket costs for you. Using the healthslips.com.au calculator, we found that the cheapest Hospital Cover for one adult in NSW that included unrestricted Back, Neck and Spine cover was a Bronze Plus policy for $129.90 per month, with a $750 excess. Don’t forget you can’t claim on your policy right away – there’s always a waiting period of 2 months on Hospital Cover policies, or 12 months if it’s a pre-existing condition. 

Claiming in-hospital pain management on health insurance 

If your doctor recommends admitting you to hospital for pain management, such as radiofrequency on a joint in your spine, it’ll be covered under Medicare in a public hospital. If you choose to be treated as a private patient, either in a public or private hospital, you’ll be covered by your Hospital Cover policy provided it includes the Pain Management clinical category – which is included in every Gold tier policy and some Bronze and Silver policies.  

Earlier this year, an episode of ABC’s Four Corners revealed that spinal cord stimulators have been linked to serious complications, leading Private Healthcare Australia (the peak body for the health insurance industry) to call for these devices to be banned. However at the time of publication spinal cord stimulators remain covered under the Pain Management with Device clinical category of Hospital Cover. This clinical category is often only included on higher-level policies – Silver and above – however using the healthslips.com.au calculator we found a few Bronze Plus policies that included Pain Management with Device cover.  

Using health insurance for back pain treatments 

If your doctor recommends non-surgical treatments for back pain, such as physiotherapy, you may be able to claim costs on health insurance. Here are the main back-pain treatments covered by Extras Cover.    

Physiotherapy 

Almost every Extras Cover policy includes Physiotherapy, which means you can get cover for a low price – however the amount you pay for premiums usually reflects how much you can claim back. No policy will cover 100% of your physiotherapy costs. According to the healthslips.com.au calculator, some policies will give you as little as $24 back per treatment with an annual limit of $390, while others pay as much as $45 per treatment, up to $900 a year. 

What’s the best health insurance for physio?

Chiropractic 

There’s some evidence that chiropractic treatment can be helpful for treating lower back pain. If your Extras Cover policy includes Chiropractic, and your chiropractor meets certain conditions, you may be able to claim back a portion of your appointments. Just as with physiotherapy, your insurer will only pay some of your costs – according to the healthslips.com.au calculator, some pay as little as $21 per appointment, while others pay 75% of the chiropractor’s fee per session, but an annual limit will apply. Sometimes limits for chiropractic are bundled up with other treatments (such as Osteopathy). 
 
Medicare also covers chiropractic appointments in certain situations – ask your GP whether you’re eligible.   

Acupuncture 

There is some evidence that acupuncture can be beneficial for lower back pain. If your Extras Cover policy includes Acupuncture, and your acupuncturist meets certain conditions (check your policy details), you may be able to claim a percentage or set-dollar amount of your treatments. Sometimes acupuncture limits are included with limits for other treatments, which means you’ll reach your annual limit faster, so it’s a good idea to look at the conditions of the policy. 

Mindfulness and stress management  

Cognitive behaviour therapy has been shown to help alleviate thoughts or feelings surrounding back pain, and many qualified psychologists practise this form of therapy. If your Extras Cover policy includes Psychology, you may be able to claim back some of your psychology session costs.  

Quit smoking 

Experts say quitting smoking can assist with back pain, and if you need support the government’s free QuitIine service is always available (and free) – call 13 78 48 or visit quit.org.au. If your Extras Cover includes Health Management/Healthy Lifestyle cover (usually only on mid-level or top level Extras Cover), you may be able to claim for a quit-smoking course.  

Stay active 

It might seem difficult to be physically active, but it’s recommended as a way to help manage lower back pain. It’s a good idea to get expert guidance to make sure you’re exercising in a way that helps your back without worsening your pain. Being active will also help you manage your weight, which is also good for minimising back pain. Your physiotherapist may be able to help you with exercise recommendations, or check whether your Extras Cover policy includes cover for Exercise Physiology – if so, work with an exercise physiology for an exercise routine tailored for your needs. 

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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