No Gap & Known Gap Urology Surgery in Sydney

If you have private health insurance and require urological surgery, North Sydney Specialists offers No Gap and Known Gap surgical options for selected procedures, subject to your health fund, level of cover, procedure and hospital.

Our aim is to make the financial side of your surgery as clear and predictable as possible. Before proceeding with surgery, our team can discuss the applicable surgical fee arrangement and help you understand any expected out-of-pocket costs.

What are No Gap and Known Gap urology surgery?

What is No Gap surgery?

A No Gap surgical arrangement means that, where applicable, the surgeon's fee is covered under the relevant Medicare and private health insurance arrangements, so there may be no out-of-pocket cost for the surgeon's surgical fee. Eligibility depends on your health fund, level of cover, procedure and individual circumstances.

What is Known Gap surgery?

A Known Gap arrangement means that where a surgical fee cannot be completely covered under a No Gap arrangement, your expected out-of-pocket contribution is discussed before surgery. The aim is to ensure that you understand the surgical fee before proceeding.

Please note that No Gap or Known Gap arrangements relate to the applicable surgical fee and do not necessarily mean that every cost associated with a hospital admission will be $0. Depending on your circumstances, other costs may include a private health insurance excess, hospital charges, anaesthetist fees, pathology, imaging or other medical services.

Urological procedures with No Gap or Known Gap options

No Gap and Known Gap options may be available for selected urological procedures for eligible privately insured patients. The applicable arrangement will depend on your health fund, level of cover, procedure and hospital.

• Kidney stone surgery: Treatment of kidney and ureteric stones, including minimally invasive stone procedures.

• Laser lithotripsy: Laser treatment to fragment urinary tract stones during endoscopic surgery.

• Ureteroscopy: Endoscopic treatment of stones and other conditions affecting the ureter.

• Prostate surgery: Surgical treatment for selected men with urinary symptoms caused by an enlarged prostate.

• Bladder procedures: Selected diagnostic and therapeutic procedures involving the bladder.

• Urinary incontinence procedures: Selected surgical procedures for appropriate patients with urinary incontinence.

• Vasectomy: Permanent male contraception where clinically appropriate.

Not every procedure will be available under a No Gap or Known Gap arrangement. Please contact our rooms to confirm the applicable arrangement for your individual procedure.

Why choose North Sydney Specialists for your urological surgery?

• Experienced specialist urological care in Sydney.

• Clear information about surgical fees before proceeding.

• No Gap and Known Gap options for selected procedures and eligible privately insured patients.

• Access to a range of urological surgical treatments, including minimally invasive procedures where appropriate.

• A focus on helping patients understand both their treatment options and expected costs.

How does the No Gap or Known Gap process work?

1. Consultation: Your urologist assesses your condition and discusses whether surgery is appropriate.

2. Procedure selection: The recommended procedure and hospital arrangements are explained.

3. Health insurance assessment: Your private health insurance details are considered to determine whether a No Gap or Known Gap arrangement may apply.

4. Fee information: Our team explains the applicable surgical fee arrangement and any expected out-of-pocket surgical cost.

5. Surgery: Once you understand the treatment and applicable costs, your surgery can be scheduled.

Frequently Asked Questions

What is No Gap urology surgery?

No Gap urology surgery refers to a surgical fee arrangement where, for eligible patients and procedures, the surgeon's fee is covered under the relevant Medicare and private health insurance arrangements.

What is Known Gap urology surgery?

Known Gap urology surgery means that an agreed or estimated out-of-pocket surgical fee is identified and discussed with the patient before surgery.

Does No Gap surgery mean I pay nothing?

Not necessarily. No Gap generally refers to the applicable surgical fee. Your health insurance excess and other hospital, anaesthetic or medical costs may still apply depending on your circumstances.

Can I have No Gap kidney stone surgery?

A No or Known Gap arrangement is usually available for selected kidney stone procedures for eligible privately insured patients. The applicable arrangement depends on your health fund, level of cover, procedure and hospital.

Can I have No Gap prostate surgery?

No Gap or Known Gap arrangements may be available for selected prostate procedures for eligible privately insured patients. Our team can confirm the applicable arrangement for your individual circumstances.

Does my private health insurance cover urology surgery?

This depends on your health fund, level of cover, waiting periods, exclusions, the procedure and the hospital. We recommend confirming your cover with your health fund before surgery.

Will I have to pay an excess?

You may have a hospital excess or other policy-related costs even where a No Gap surgical arrangement applies. Your individual health insurance policy determines whether an excess is payable.

Will there be an anaesthetist fee?

Anaesthetic fees are separate from the surgeon's fee and may have their own No Gap or Known Gap arrangements. You should ask the anaesthetist or their rooms about any expected out-of-pocket cost.

How do I find out my exact surgical costs?

Contact our rooms after your consultation and provide your private health insurance details. Our team can explain the applicable surgical fee arrangement and any information available about expected costs.