“What Will It Cost?” Medicare, Private Health and Jaw Surgery in Australia
Summary
Jaw surgery can involve fees from a surgeon, an anaesthetist, a hospital and an orthodontist, each covered differently by Medicare and private health insurance. This guide is for people planning jaw surgery and for those who were hit with costs they didn’t expect, including costs of fixing a complication. It explains who pays for what, what you should be told in writing, and where to go if things went wrong.
Quick answer · updated November 2026
Oral and maxillofacial surgeons can claim some Medicare rebates, but not all hospital policies cover all jaw surgery, and some procedures may fall under exclusions. Before surgery you should get a written estimate listing item numbers and fees, then check it with your fund. If costs were hidden, or you are paying to fix a complication, you can ask questions and complain.
Paying for jaw surgery at a glance
- 1PlanningWork out who will bill you: surgeon, anaesthetist, hospital, orthodontist.
- 2Written estimateAsk for item numbers, fees and provider numbers in writing.
- 3Check your fundAsk what they will pay, and about exclusions and waiting periods.
- 4Surgery and billsCompare the bills with the estimate.
- 5If things go wrongAsk who pays for corrective treatment.
At any stage: keep every quote, bill and letter. They become your record.
I was twenty-three and had saved for two years. The surgeon’s receptionist gave me a single page with one number on it, and said the rest “should be mostly covered” by my health fund.
I had hospital cover. I thought that meant I was fine.
The week after surgery, still swollen and living on smoothies, I opened a bill from the anaesthetist I hadn’t expected. Then one from the hospital. Then my fund wrote to say part of the procedure was excluded on my policy.
I sat on my bedroom floor with the letters spread out, unable to open my mouth to cry properly.
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
If you were caught out by the cost of jaw surgery, or you are planning surgery and want to avoid that, I want you to know that you are entitled to clear information about costs before you agree. Money questions are not shallow questions. They shape real decisions.
This guide covers who bills for what, how Medicare and private health insurance fit in, what you should be told in writing, what happens when a complication needs more treatment, and where to take concerns.
Why I can write this
I have been a medical negligence lawyer since 2014 and have worked on many hundreds of claims, including many involving jaw and oral surgery. My doctorate looked at patterns of failure in medical negligence. I am not medically qualified. The clinical facts in this article are checked against named sources, listed in the references, and I explain how I work in our editorial standards.
Start with your question
- Who bills for jaw surgery?
- Does Medicare cover jaw surgery?
- Does private health cover jaw surgery?
- What should a written estimate include?
- Who pays if something goes wrong?
- Where can I complain about costs?
- Could this be medical negligence?
Who bills for jaw surgery
Jaw surgery usually involves several separate bills. The oral and maxillofacial surgeon, the anaesthetist and the hospital each charge their own fees. Many people also pay an orthodontist for braces before and after surgery. Each may be covered differently.
Definition
Informed financial consent means being given clear information about the expected costs of treatment, before treatment, so you can decide whether to go ahead.
In plain terms: you should know roughly what you will pay before you say yes.
Medicare
Oral and maxillofacial surgeons are registered as both dental and medical specialists, and can claim Medicare rebates for a range of services they provide.1 Whether a particular jaw operation attracts a Medicare rebate depends on the procedure and your circumstances. Ask your surgeon which Medicare item numbers they will use.
For the anaesthetist, the Ombudsman explains that for an in-hospital service Medicare generally pays 75% of the Medicare Schedule Fee and your fund pays the remaining 25%. Anything charged above the schedule fee is a gap you pay yourself.2
Private health insurance
The Ombudsman warns that not all hospital policies cover all types of oral and maxillofacial surgery.2 ANZAOMS notes that some procedures may be listed under “Plastic and Reconstructive” and excluded, depending on your policy and circumstances.1 Some oral surgery is paid from extras (general treatment) cover rather than hospital cover, and waiting periods may apply.2
Questions to ask your fund
- Is this procedure covered on my hospital policy, using these item numbers?
- Is any part excluded or restricted?
- Do I have an excess or co-payment?
- Is my hospital an agreement hospital with this fund?
- Have I served any waiting periods?
The written estimate
The Ombudsman recommends asking for a written quote listing the item numbers, the cost, and the provider’s name and provider number, and then checking your benefits with your fund. For hospital admissions, you should get a fee estimate beforehand so you can give informed financial consent.2 Ask for separate estimates from the surgeon, the anaesthetist and the hospital.
When the bills arrive
Compare each bill with the estimate. If the item numbers or fees differ, ask why in writing. Sometimes surgery changes on the day for good clinical reasons, but you are still entitled to an explanation.
When a complication needs more treatment
If something goes wrong, such as a plate infection, a nerve injury or a bite that relapses, you may need further surgery, more orthodontics or other treatment. Ask your surgeon in writing who will pay for corrective treatment, and whether they will charge for it. If the complication was caused by care that fell short, those costs may form part of a claim. Our guides to plate infection, numbness after jaw surgery and relapse explain those complications.
Where to take a cost concern
Questions or complaints about your health fund can go to the Private Health Insurance Ombudsman on 1300 362 072.2 Concerns about a practitioner’s care or conduct in NSW can go to the Health Care Complaints Commission.3 Our guide to complaint or claim explains the difference.
My fund’s letter said the excluded item was under “plastic and reconstructive”. My policy didn’t include it. I hadn’t been asked which policy I had, and I hadn’t known to ask.
Six months later one of my plates got infected and had to come out. The surgeon’s rooms sent another quote.
This time I asked for everything in writing first, with item numbers. I rang my fund with the numbers. I asked the surgeon’s practice manager, politely, whether they would charge for removing a plate from their own operation. They reduced the fee.
My dad helped me put the letters into a folder, in order. “You should have had all this before the first one,” he said. He was right.
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
What to look for in the records
Your records are often where the story becomes clear. You have a right to access your own health information. In NSW the Health Records and Information Privacy Act 2002 covers both public and private providers, and the Information and Privacy Commission explains how to ask.4 Our step-by-step guide to getting your medical records in Australia walks you through it.
| Record | Why it matters |
|---|---|
| Written estimates | Show what you were told the surgery would cost, and by whom. |
| Consent forms | Show what risks and costs were explained before surgery. |
| Your policy documents | Show what your fund covered and excluded at the time. |
| Bills and Medicare statements | Show the item numbers actually charged. |
| Fund correspondence | Shows what was paid and what was refused, and why. |
| Costs of corrective treatment | Show what you have paid because of a complication. |
| Your own diary, photos and messages | Notes made at the time are evidence too. Keep them. |
How the law looks at it
An unexpected bill is not, by itself, medical negligence. But costs can matter in two ways. First, a surgeon must tell you about material risks before you agree, and some people would decide differently if told about likely costs and risks of further surgery. Second, if a complication was caused by care that fell short, the cost of fixing it can form part of a claim.
A claim usually turns on three questions: whether the care fell below what peers would widely accept as competent practice (section 5O of the Civil Liability Act 2002 (NSW))5, whether that shortfall probably caused harm you wouldn't otherwise have had (Tabet v Gett)6, and, where it matters, whether you were told the material risks first (Rogers v Whitaker)78. Our guide to how a medical negligence claim works explains each one in plain terms.
In a cost-related jaw surgery case, the questions might be: were you told about the risks that led to further treatment? Was the complication caused by care below the accepted standard? What have you paid, and will you pay, because of it?
In plain terms, the question is whether better care would probably have avoided the complication, and with it the extra costs.
For jaw surgery, that would usually include the risks of nerve injury, infection, relapse and further surgery.
Who can claim, and when
The person who had the surgery can claim. In NSW, time usually runs from when you knew, or ought to have known, enough to claim, not from the treatment itself, and courts can sometimes extend it, so an old injury may still count. See time limits in NSW or other states, and ask early.
More: complaint or claim? · how a claim is paid for · what a claim can cover
In my practice
In jaw surgery files, I often see a single-page quote with one figure, and nothing about the anaesthetist, the hospital or the policy exclusions. When a complication follows, the person faces a second round of costs with even less information. Laying out the quotes and bills in order often shows clearly where information was missing.
Both things can be true
Your surgeon may have done careful surgery, and you may still have deserved clearer information about costs. And a complication may be a recognised risk while the cost of fixing it is still a fair question to ask.
The bigger picture
The AMA and ANZAOMS have worked on guidance about informed financial consent.1 You can check your surgeon’s registration on the Ahpra public register.9
See the rest of the series: trismus, BSSO vs double jaw and regret after jaw surgery.
Support
You don't have to work through this alone. These services can help:
- Lifeline, 24-hour crisis support: 13 11 14 (listed on healthdirect's helplines page)10
- Beyond Blue, anxiety and depression support: 1300 22 4636
- Medicare Mental Health, help finding mental health support: 1800 595 212
- healthdirect, 24-hour nurse advice: 1800 022 222
- Health Care Complaints Commission (NSW): 1800 043 159
A young woman on her bedroom floor surrounded by bills now has a folder in order, and knows the questions to ask. You deserve that too.
With care,
Rosemary
Frequently asked questions
Does Medicare cover jaw surgery?
Some services by oral and maxillofacial surgeons attract Medicare rebates. Ask which item numbers apply to your surgery.
Does private health insurance cover jaw surgery?
Not all hospital policies cover all oral and maxillofacial surgery. Check with your fund using the item numbers.
What should a written estimate include?
The item numbers, fees, and the provider’s name and provider number, for each provider.
Why did I get a separate anaesthetist bill?
Anaesthetists bill separately. Any amount above the Medicare Schedule Fee may be a gap you pay.
Who pays if my jaw surgery goes wrong?
Ask in writing. If care fell short, the cost of corrective treatment may form part of a claim.
Where can I complain about my health fund?
The Private Health Insurance Ombudsman, on 1300 362 072.
Questions about jaw surgery costs?
When you're ready, and not before, I can look at what happened and help you understand your options.
Jaw surgery: recovery, complications and your rights
- “Is it too late?” Time limits and what a jaw surgery claim can cover
- “I can still only fit two fingers in”: Restricted mouth opening (trismus) after jaw surgery
- “Should my BSSO have been double jaw?” How surgeons plan BSSO vs bimax
- “Biggest mistake of my life”: Regret after jaw surgery
- “My lip and chin are still numb”: Nerve injury after jaw surgery
- “What will it cost?” Medicare, private health and jaw surgery in Australia (you are here)
- “Nobody told me it would take this long”: Double jaw surgery recovery timeline
- “My bite has shifted”: Relapse after jaw surgery
- “The plate is poking through”: Infection and plates after jaw surgery
- “I didn’t know that was a risk”: Consent before jaw surgery
- “My jaw clicks and locks now”: TMJ pain after jaw surgery
- “Do I need it redone?” Second opinions and revision jaw surgery
Part of our guide to oral, maxillofacial and dental negligence. Not sure where you stand? Try the free claim checker.
References
- Australian and New Zealand Association of Oral and Maxillofacial Surgeons. Medicare, private health insurance and your fees.
- Commonwealth Ombudsman (Private Health Insurance). Dental and oral surgery.
- Health Care Complaints Commission NSW. Home page.
- Information and Privacy Commission NSW. Fact sheet: Accessing your health information in NSW.
- Civil Liability Act 2002 (NSW) s 5O, Standard of care for professionals.
- Tabet v Gett [2010] HCA 12.
- Rogers v Whitaker [1992] HCA 58; (1992) 175 CLR 479.
- Australian Commission on Safety and Quality in Health Care. Informed consent.
- Australian Health Practitioner Regulation Agency. Register of practitioners.
- healthdirect Australia. Mental health helplines.
Stories in this article are composites, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. They do not describe any individual client.
Dr Rosemary Listing, PhD (Law), Medical negligence lawyer since 2014 · Of Counsel, Peter Evans & Associates. Rosemary's doctorate examined patterns of failure in medical negligence, and she teaches health law at the University of Newcastle. She is not medically qualified. About Rosemary.
Last updated: 10 November 2026 · First published: 10 November 2026 · Next review: May 2027
Cite this article: Listing R. “What will it cost?” Medicare, private health and jaw surgery in Australia. Reframe Legal. Published 10 November 2026. https://reframelegal.com/jaw-surgery-cost-medicare-private-health/
This article is general information, not legal or medical advice. It does not create a lawyer–client relationship. Speak to your treating clinicians about your health, and get legal advice about your own situation.
If you are in danger or need urgent medical help, call 000. For crisis support, call Lifeline on 13 11 14.
Legal services are provided by Peter Evans & Associates.
