Heart valve replacement
What is heart valve replacement?
Heart valve replacement is a surgery that treats heart valve disease by replacing the diseased heart valve with a mechanical valve or one made from cow, pig or human heart tissue (biological tissue valve).1 It is performed in hospital, under general anaesthetic (you’ll be asleep), and is used to treat serious cases.1
Heart valve disease impairs the heart’s function which can cause chest pain, shortness of breath, and other symptoms.1
After surgery, your breathing should be improved and you should have less chest pain, more energy, and a better quality of life.1
Heart valve replacement is performed by a cardiothoracic surgeon.
There are several different heart valve replacement surgeries, with different medical terms such as aortic valve replacement and mitral valve replacement.
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Public and private hospital options
It’s important to understand how getting your procedure in a public or private hospital differs.
| Question | Public system (Without health insurance) | Private system (With health insurance) |
|---|---|---|
| Will I avoid public hospital waiting lists? |
No. |
Yes. |
| Will I be able to choose my hospital? |
No. |
Yes. |
| Will I be able to choose my doctor or surgeon? |
No. |
Yes. |
| Will I have out-of-pocket costs? |
No. |
Yes. |
What’s covered in a public hospital?
In a public hospital, heart valve replacement is covered by Medicare for eligible residents.
Once you are discharged from hospital, you may still need to pay out-of-pocket for things like medicines and health services (like physiotherapy or occupational therapy).
What’s covered in a private hospital?
In a private hospital, private health insurance can cover some costs of heart valve replacement.
You may have an out-of-pocket cost if you use private hospital cover when you get treatment. You can minimise some of these costs by choosing a hospital and specialist that have agreements with your health insurer.
If you have an excess on your cover, you will have to pay for that out of pocket.
What is hospital excess?
Hospital excess is the amount of money you contribute upfront (out of your own pocket) before you can claim a benefit on hospital treatment. With HBF hospital cover, you choose an excess option when you first get hospital cover, but you can change your excess at any time.
With HBF, you only pay hospital excess once per person, per calendar year (to a maximum of twice on a family policy) when you’re admitted to hospital.
Are you an HBF member? You can check your excess in myHBF or the HBF App. This is the set amount you’ll pay when you’re admitted.
What is an out-of-pocket cost?
A hospital out-of-pocket cost is the portion of a hospital bill that you pay from your own pocket for which you won’t be reimbursed – by either health insurance or Medicare.
How to find health cover for heart valve replacement
If you want private health insurance cover for heart valve replacement, look for HBF hospital cover (not extras cover) that includes a category called ‘Heart and vascular system’.
You need to hold hospital cover that includes ‘Heart and vascular system’ for two months before you can claim for a heart valve replacement (or 12 months if you need a heart valve replacement due to a pre-existing condition).
Ask your GP for an open referral
Your GP is the one who’ll most likely refer you to a specialist – but you may want the option to choose your own specialist.
Asking for an open referral can let you:
- Choose your own specialist.
- Find a specialist with good availability who can perform treatment at the hospital you prefer.
- Find a specialist that you trust to perform your surgery.
- Find a specialist with minimum out-of-pocket expenses for you.
Find an surgeon with minimum out-of-pocket costs
To find cardiothoracic surgeons who have an agreement with HBF, just search for ‘cardiothoracic surgeon' in our find a provider tool.
- Look for the “Full Cover” tick mark or “Access Gap Cover” tick mark.
- These specialists will help minimise your out-of-pocket cost.
If you’ve already started working with a specialist
If you’ve already got a specialist, ask them these questions:
- Do you have a Full Cover or No Gap agreement with HBF?
If they don’t, you may need to consider if their fees work with your budget. - What hospital(s) do you operate in?
You can then check if the hospital has a Full Cover or No Gap agreement with HBF.
Signs you might have heart valve disease
Heart valve disease can cause mild to severe symptoms including:1
- Abnormal sound when listening with stethoscope (heart murmur).
- Chest pain.
- Fainting, dizziness or light-headedness.
- Irregular heartbeat.
- Palpitations (very fast fluttering, racing, thumping or a pounding feeling in your chest).
- Shortness of breath.
- Swelling of ankles and feet.
- Tiredness.
Heart valve replacement recovery
Heart valve replacement surgery is an intensive procedure, and full recovery takes several weeks to months.2, 3
- After surgery, you’ll spend a few days in an intensive care unit (ICU) to be monitored during early recovery.
- You should be able to go home after 7 to 10 days.
- Full recovery can take several weeks to months, during which you will slowly return to normal activity.
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Further reading
1 Heart Foundation - Heart Valve Disease (2023)
2 Health Direct - Mitral Valve Surgery (2023)
3 St. Vincent’s Hospital - Heart Valve Surgery (2021)