Rotator cuff surgery
What is rotator cuff surgery? 1
The rotator cuff is a group of muscles and tendons that attach your arm to your shoulder blade.
Rotator cuff surgery is a surgical procedure that can repair the two most common types of rotator cuff injury:
- Rotator cuff tear — often caused by lifting heavy objects or falling.
- Rotator cuff degeneration — caused by age, wear and tear, and genetic factors.
This surgery is performed in hospital under general anaesthetic (you’ll be asleep) and takes 45 minutes to an hour
The surgery can reduce pain and improve shoulder movement – but it’s usually only considered if other treatments are not helping.
Rotator cuff surgery is performed by an orthopaedic surgeon.
Medical terms for this procedure include ‘rotator cuff surgery’ or ‘rotator cuff repair’.
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What is the cost of rotator cuff surgery?
What’s covered in a public hospital?
In a public hospital, rotator cuff surgery 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 rotator cuff surgery.
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 a set 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 rotator cuff surgery
If you want private health insurance cover for rotator cuff surgery, look for HBF hospital cover (not extras cover) that includes a category called ‘Joint reconstructions’.
You need to hold hospital cover that includes 'Joint reconstructions' for two months before you can claim for rotator cuff surgery (or 12 months if you need rotator cuff surgery due to a pre-existing condition).
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. |
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 a surgeon with minimum out-of-pocket costs
To find orthopaedic surgeons who have an agreement with HBF, just search for ‘orthopaedic 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 need rotator cuff surgery2
Rotator cuff surgery is usually only considered if lifestyle changes, medicines and other treatments like physiotherapy are not helping.
Here are some signs that you may need rotator cuff surgery:
- Pain and tenderness at rest and at night, particularly if lying on the affected shoulder.
- Pain or weakness when lifting and lowering your arm or with specific movements.
- A crackling sensation when moving your shoulder in certain positions.
Shoulder pain can be caused by many different things, so you should see a doctor and get a proper examination before assuming you have a rotator cuff injury.3
Alternatives to rotator cuff surgery2
- Physiotherapy.
- Rest.
- Limiting overhead activities.
- Nonsteroidal anti-inflammatory drugs (NSAIDs).
- Strengthening exercises.
- Steroid injection.
Rotator cuff surgery recovery1
Most patients leave hospital one day after rotator cuff surgery, but it can take up to a year to regain the strength to use your shoulder normally again.
Here are some things to keep in mind during your recovery:
- Seeing a physiotherapist and doing the recommended rehabilitation exercises can help speed up recovery.
- Regular exercise can help you to return to normal activities as soon as possible.
- You may not get back the same strength that you had before you damaged your shoulder.
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Further reading
1 Health Direct - Shoulder Surgery Rotator Cuff (2023)
2 OrthoInfo - Rotator Cuff Tears (2023)
3 Health Direct - Rotator Cuff Injury (2023)