Surgery

We can help pay for surgery in the first 90 days after your accident. You do not need to contact us for approval first if:

  • you have a TAC claim number
  • your doctor or other health professional recommends it, and
  • it is for your accident injuries.

For surgery more than 90 days after your accident, we will pay for a visit to your doctor to find out if you need surgery.

How to get surgery after 90 days from your date of accident

  1. See your doctor for a referral if you need surgery for an accident related injury
  2. Choose a surgeon. Your doctor can recommend one, or you can also search for a surgeon online.
  3. Call and make an appointment. Tell them you are a TAC client, you have a referral and who the referral is from.
  4. At your consultation, ask your surgeon to write to the TAC. We need this information before we can approve your surgery:
    1. A description of the surgery you need that includes Medicare item numbers
    2. Clinical justification about how the surgery relates to your transport accident injuries
    3. Information about your expected recovery time, the rehabilitation services you'll need and any limitations you'll have after surgery
  5. We will use this information to make a decision about your surgery. We will write to you and your surgeon to let you know if we can approve the surgery.

How to pay for treatment

We will pay your providers for your surgery, including anaesthesia.

We will pay for your surgery according to our fee schedule. If your provider charges more than the TAC rate, you may need to pay the difference. For a list of our rates, see: Medical services reimbursement rates.

Information for health and service providers

If you are a specialist, surgeon or anaesthetist, please refer to our TAC provider guidelines.

Medical services reimbursement rates

The TAC has adopted the Medicare Benefits Schedule (MBS) items, explanations, definitions, rules and conditions for services provided by medical practitioners.  When invoicing for medical services, medical practitioners are expected to adhere to the MBS rules unless otherwise specified by the TAC on the Reimbursement Rates for Medical Services information page or its medical policies.

The Reimbursement Rates for Medical Services must be read in conjunction with:

At the time of production this publication contained up to date information as released by Medicare Australia (Medicare).  The relevant publication will be updated to reflect any further changes that are implemented by Medicare each year.  Please check our website for the latest version.

If you have any questions about these publications or the reimbursement rates, please contact the TAC on 1300 654 329. Alternatively, e-mail info@tac.vic.gov.au.

Surgery and medical specialists

We’re here to help you get your life back on track after your transport accident. To help you recover we will pay for consultations and treatment with appropriate and qualified medical specialists and surgeons in Australia.

There are two types of surgery:

  • Emergency surgery – urgent surgery to save the person’s life or preserve function of a body part.
  • Elective surgery – non-urgent surgery required for your ongoing health or quality of life.

What will my surgeon or specialist do?

You might require surgery, or a consultation with a medical specialist, to help with your transport accident injuries. Your surgeon or specialist may carry out diagnosis, prevention, reconstruction and transplantation procedures.

In the first 90 days after your accident, surgery is approved

We will pay for emergency surgery or elective surgery you need because of your accident injuries within the first 90 days of the date of your accident.

Surgery after 90 days from the date of a transport accident

If you need elective surgery after 90 days from the date of your accident, we will pay for a consultation with your doctor. After that consultation your doctor may then refer you to a specialist or surgeon to treat your transport accident injuries.

We require a letter from your surgeon:

  • Describing the surgery or procedure required, including Medicare item numbers.
  • Providing a clinical justification for how the surgery relates to your transport accident injuries.

We may contact your surgeon or specialist to discuss your progress or request an assessment to make sure that:

  • You have access to appropriate treatment and supports required for your transport accident injuries.
  • You are getting proven, evidence-based treatment and not receiving treatment that isn't helping you recover.
  • You are moving towards getting your life back on track and being able to live independently.

How surgery and specialist treatment is paid for

We pay for your treatment:

  • Directly to your surgeon or specialist, when you have given them your TAC claim number, or
  • If you have to pay, use myTAC to send a copy of your receipt to us and we will repay you.

We pay for your services in line with our responsibilities under the Transport Accident Act 1986.

How much we will pay

We will pay for your surgery, including anaesthesia, when you are admitted to hospital and require surgery as a result of your transport accident injuries. We can also pay the cost of subsequent elective surgery required as a result of your transport accident injuries.

We will pay for your treatment and services according to our fee schedule. If your provider charges more than the TAC rate, you may need to pay the difference. If you have already paid for your surgical treatment we can repay those expenses up to our maximum amount.

For a list of TAC rates, see: Elective surgery.

For accidents that happened before 14 February 2018, we can only pay for these services once any required medical excess has been reached. Find out if the medical excess applies to you.

What we won’t pay for

We can’t pay for services that:

  • Do not treat your transport accident injuries.
  • Are not reasonable, necessary or appropriate.
  • Are not clinically justified, safe and effective.

For providers

If you are a specialist, surgeon or anaesthetist, please refer to our TAC provider guidelines.