Shoulder replacement surgery
What is shoulder replacement?1
Shoulder replacement is a type of surgery in which a damaged shoulder joint is replaced with an artificial one.
Shoulder replacement is usually recommended to treat severe pain or disability.
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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, shoulder replacement 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 physiotherapy.
What’s covered in a private hospital?
In a private hospital, private health insurance can cover some costs of shoulder replacement 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 shoulder replacement surgery
If you want private health insurance cover for shoulder replacement surgery, look for HBF hospital cover (not extras cover) that includes a category called ‘Joint replacements’.
You need to hold hospital cover that includes Joint replacements for two months before you can claim for shoulder replacement surgery (or 12 months if you need shoulder replacement surgery due to a pre-existing condition such as osteoarthritis).
Ask your GP for an open referral
Your GP is the one who’ll most likely refer you to a specialist – but they may not recommend the specialist you’d want to perform your surgery. 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 orthopaedic surgeon with minimum out-of-pocket costs
To find orthopaedic surgeons who work 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 shoulder replacement2
Shoulder replacements are usually only considered if lifestyle changes, self-management techniques, medicines and other treatments like physiotherapy are not helping.
Here are some signs that your shoulder may need some kind of treatment:
- Severe joint damage from osteoarthritis or rheumatoid arthritis.
- Moderate or severe shoulder pain while resting.
- Shoulder pain that doesn’t improve with rest or medications.
- Recurring or frequent dislocations.
- Rotator cuff tears.
Alternatives to shoulder replacement3
- Exercise-based rehabilitation.2
- Physiotherapy.
- Medicines.
- Steroid injections into shoulder.
Related: Physio cover you can feel good about
Get help managing shoulder pain with extras cover that includes physiotherapy.
Shoulder replacement recovery3
Most patients leave hospital two to three days after shoulder replacement surgery. For a few weeks following surgery, you will need to keep your arm in a sling.
Seeing a physiotherapist and doing the recommended rehabilitation exercises can help speed up recovery. Private health insurance can help with physiotherapy costs too, if you get extras cover that includes physiotherapy.
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More ways we can help
1 OrthoInfo - Shoulder joint replacement (2021)
2 Better Health - Shoulder pain (2022)
3 Healthdirect - Total shoulder replacement