New “No Gap” Trial for Private Health Cover Patients

joint replacement surgery video screenshot

New cooperation between private hospital operator, doctors and health insurer guarantees “no gaps” for patients having joint replacement surgery. 

Vermont Private Hospital (part of the Nexus Hospitals Group) in Melbourne’s eastern suburbs is the first to offer a new style of private health insurance arrangement guaranteeing that patients needing joint replacement can have their surgery with no out-of-pocket costs.

The new service is a first-of-its-kind cooperative arrangement between private hospital, doctors and private health insurer which eliminates out of pocket costs for privately insured patients and implements an innovative model of care which reduces the time patients need to stay in hospital.

Nexus Hospitals CEO Andrew Petering says the new ‘Zero Out of Pocket’ or ‘ZOOP’ arrangement is aimed at giving patients certainty that – apart from any applicable excess under their policy – all other costs for their hospital admission will be covered by their private health insurance.

“Patients with private health insurance want their insurance to cover all of their out of pocket costs.  Historically, private health insurance in Australia hasn’t been able to provide that certainty because of the way that the healthcare system is regulated.

“When you take out car insurance, you know that if you need to use it, all of your costs are covered.  All you pay is a pre-agreed excess and everything else is taken care of by your insurance company.  We’ve introduced ZOOP to give patients with health insurance that same peace of mind.”

Under the new arrangement, patients will also receive cover for additional services both before and after their hospital stay, aimed at improving their recovery and helping patients get back on their feet faster.  These include “prehabilitation” assessment and education by a specialist physiotherapist to optimally prepare them for surgery, access to smartphone app technology to customise their recovery, and options to receive nursing and rehabilitation care at home.

Orthopaedic surgeon Dr Daevyd Rodda was the first surgeon to perform joint replacements at Vermont Private Hospital under the ZOOP initiative.  He said he has wanted to be able to offer this kind of service to patients for some time, but the way the healthcare system is regulated couldn’t guarantee patients wouldn’t pay a gap.

“Eliminating out of pocket costs for patients is the holy grail for private hospital care.  The only way we can ensure no gaps for patients is to have doctors, the private hospital and the private health insurer cooperating to ensure everything is covered.”

“One of the first patients to have their knee replacement at Vermont Private also needs to have her other knee as well as a hip replaced.  Without access to this kind of arrangement she would have had significant out of pocket expenses to cover the cost of all three surgeries, which was prohibitive for her.  Now, she can use her health insurance and be fully covered with no gaps.”

Nexus Hospitals Chief Operating Officer, Scott Bell, says that the additional support services provided before and after surgery means that patients are able to have a much shorter hospital stay after surgery.  A recent patient of Dr Rodda’s was able to have a total knee replacement surgery and was discharged home the same day – the first such procedure performed in Australia as day surgery.

“New surgical and anaesthetic techniques for joint replacement mean that patients can be back on their feet and recovering much faster.  With the right support in place at home, research has shown time and again that patients have better outcomes and a better experience when they recover in the comfort of their own home.”

“The average stay in Australian hospitals after hip or knee joint replacement surgery is over four days, plus many patients have an additional stay for rehabilitation which can be a week or more.  In other countries length of stay has been shortened dramatically in recent years as new surgical techniques have been introduced, and in the US and Europe many hip and knee replacements are being performed as day surgery or discharged the next morning.”

Medibank is the first Private Health Insurer to support the Nexus ZOOP arrangement for joint replacement surgery at Vermont Private Hospital.  Nexus and Medibank are proposing to expand the arrangement to cover joint replacement surgery in other locations around Australia, and Nexus is also looking at expanding the arrangement to offer no-gap surgery for other treatments such as hernia repair.

About Dr Daevyd Rodda:

Dr Daevyd Rodda is a specialist orthopaedic surgeon and a renowned expert in lower limb joint replacement surgery. He has trained extensively around Australia and at various centres of excellence in Europe and North America. He has a special interest in Anterior approach, minimally invasive total hip replacement and rapid recovery total knee replacement. He performs several hundred of these procedures each year and teaches these complex operations to other surgeons around Australia.

Dr Rodda is Director of Victorian Orthopaedic Group, located in Kew, Victoria. Ph: 03 9853 7099.

About Vermont Private Hospital:

First opening in 2016, Vermont Private Hospital is a short stay hospital offering surgical care in orthopaedic surgery, ophthalmology, plastic and reconstructive surgery, chronic pain and other specialties.  Vermont Private is part of the Nexus Hospitals Group. Ph: 03 8547 1111.


Scott Bell  0414 686 073