Navigating the intricacies of healthcare can be daunting, especially if you are looking for health insurance that is covering your cosmetic surgery in Australia. In our latest blog post, we shed light on the policies, procedures, and critical details that can help inform you about what is, and what isn’t covered, when it comes to your cosmetic surgery.
The Basics of Health Insurance Policies in Australia
Every health insurance policy in Australia offers a different level of cover for various treatments, ailments, and procedures, both cosmetic and otherwise. And so, it’s crucial to understand the specifics of your policy and whether it covers cosmetic surgery procedures to avoid any unexpected out-of-pocket expenses.
In general, most private health insurances will not cover cosmetic surgery that is done for aesthetic reasons. However, there can be exceptions if the cosmetic surgery being considered is deemed “Medically Necessary”.
How Does Insurance Determine ‘Medically Necessary’ Procedures
The term “medically necessary” will play a pivotal role in deciding whether a cosmetic surgery procedure is covered by your private health insurer or not. Medically necessary cosmetic surgery differs from purely cosmetic surgery. For instance, a breast reconstruction following traumatic events or mastectomy can be deemed medically necessary, while a breast augmentation for aesthetic reasons will not be.
Common Cosmetic Procedures Covered by Insurance
This is not an exhaustive list, but these are an example of some of the cosmetic procedures that could be covered under private health insurance, because they were deemed as “medically necessary”.
- Reconstructive surgery procedures after an accident or trauma.
- Treatments for conditions with a significant impact on the persons’ health or wellbeing.
- Breast reconstruction after mastectomies.
- Procedures to address congenital deformities.
- Surgeries to rectify damage from skin cancers or other diseases.
- Treatments following significant weight loss, where the removal of loose skin could be required to improve the patient’s physical wellbeing.
Reading the Fine Print: What to Look For
Navigating insurance policies for cosmetic surgery requires careful attention to detail. Before committing to a policy, it’s crucial to thoroughly examine your policies’ terms and conditions to avoid unexpected challenges later on. Key aspects to look out for include:
- Coverage specifics
- Extent of coverage
- Waiting periods
- Exclusions
- Associated Costs
- Preferred Providers
- Claim Processes
- Policy Premiums
Benefits and Limitations of Different Insurance Plans
Different health insurance policies provide varying benefits. While some may offer comprehensive coverage for cosmetic surgery procedures, others might have stringent limitations, especially concerning cosmetic and plastic surgery procedures. It’s imperative to evaluate the pros and cons of each policy to identify which best aligns with your needs.
The Role of Medicare in Cosmetic Surgery
Medicare in Australia doesn’t just cater to general health procedures. It also covers specific cosmetic and reconstructive surgeries based on medical necessity. These are outlined in the Medicare Benefits Schedule, and it’s crucial to see how they can complement your private health insurance. Key procedures include:
- Breast reconstruction – after mastectomies due to cancer or other medical conditions
- Cleft lip and palate surgery – for children born with these congenital conditions
- Eyelid surgery (Blepharoplasty) – when drooping eyelids impact vision
- Rhinoplasty – only when it’s required for breathing issues or after trauma
- Skin grafts – for burns or significant skin loss
- Varicose vein procedures – when medically indicated
- Removal of certain skin lesions or tumours – when there’s a potential health risk
It’s vital to note that even if a procedure is listed on the Medicare Benefits Schedule, it doesn’t mean Medicare will cover the entire cost. There may still be out-of-pocket expenses. Additionally, the context and medical necessity are crucial; just because a procedure type is listed doesn’t mean it’s covered for all situations.
Tips for Acquiring the Right Coverage
Choosing the right private health insurance cover isn’t merely about premiums. It’s about ensuring your policy genuinely aligns with your health and cosmetic needs.
Comparing Various Health Insurance Providers
Multiple private health funds operate in Australia, each with unique offerings. When seeking insurance for cosmetic surgery, it’s crucial to compare the benefits, exclusions, and premiums of various providers. This helps in making an informed choice tailored to your individual needs.
Asking the Right Questions Before Choosing a Policy
Before settling on a private health insurance policy, make sure to ask pertinent questions. Understand the criteria that differentiate medically necessary procedures from purely cosmetic surgery, the waiting periods, and any other terms that may impact your decision.
How to Make a Claim for Cosmetic Surgery
Even before you’ve undergone a procedure, understanding how to make a claim after you would have the surgery, is very important. Ensuring that your selected surgeon can provide you with all of the necessary documentation, can help avoid future shock if you weren’t able to source all the required documentation and need to pay for the surgery yourself.
Get in Touch
To find out more information about our procedures, or to book a consultation with one of our surgeons give us a call or complete the form.
Reminder: You will need a GP referral for any cosmetic surgery procedure. Guidelines have changed and AHPRA requests that all patients who have a cosmetic or medical procedure must now have a GP referral approving your suitability for the procedure in question (medically necessary or not). You can fax your referral to 02 8072 6824 or email office@drzacharia.com.au.
FAQs
Can you Claim Cosmetic Surgery on Private Health Insurance?
Yes, certain cosmetic surgeries can be claimed on private health insurance, especially if they’re deemed medically necessary. However, purely cosmetic procedures are often excluded. Always check the specifics of your policy to understand the extent of your coverage.
Is Cosmetic Surgery Covered by Medicare Australia?
Medicare Australia does cover some cosmetic surgeries, but typically those that are deemed medically necessary, such as reconstructive surgery and post-traumatic events. The Medicare Benefits Schedule provides a comprehensive list of covered procedures, so it’s recommended to consult this when in doubt.
Does Private Health Insurance Cover a Tummy Tuck?
A tummy tuck, or abdominoplasty, may be covered by a private health fund if deemed medically necessary. For example, following significant weight loss that has led to excess skin causing health issues. However, if pursued purely for aesthetic reasons, it might not be covered by your health insurer.
