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What Is Cosmetic Surgery And Am I Covered?

What Is Cosmetic Surgery And Am I Covered?

What is Cosmetic Surgery?

  • Any surgical procedure performed to enhance your appearance.
  • Can be facial or the body.

How does cosmetic surgery differ from other surgery?

  • It is always elective and not ever urgent.
  • Most surgery is done to fix problems, but the end result aesthetic appearance is not the primary concern.
  • Cosmetic surgery is performed to fix problems and have you look as normal and / or as good as possible as an end result

When did cosmetic surgery come about?

  • Cosmetic surgery started life as reconstructive surgery following the disfigurement suffered by bombing victims after the World Wars.

What is the difference between cosmetic surgery and plastic surgery?

  • These are one and the same
  • In the early days of the specialty, surgeons chose the term “plastic” from Greek term “plasticos” which means “to mould”, as they were moulding new features.
  • As more people turned to plastic surgery for elective enhancement, non-trained doctors started calling themselves “cosmetic surgeons”.
  • Most of these do not even have surgical qualifications
  • Only plastic surgeons are qualified to perform cosmetic surgery.
  • Australian Society of Plastic Surgeons website explains this in detail www. plasticsury.org
  • Be careful when choosing a surgeon and ensure they are qualified surgeons.
  • Look for FRACS behind their name. This is the only recognised surgical qualification in Australia.

Does Medicare cover cosmetic surgery?

  • Medicare guidelines are very strict
  • Some cosmetic procedures, such as breast reduction are always Medicare eligible. There is no fine print.
  • Most cosmetic procedures will have Medicare eligibility if they are performed on one side to improve asymmetry.
  • Every procedure ha specific guidelines.
  • The only way to check if the cosmetic surgery you are interested in is Medicare eligible is to have a consultation with your surgeon.

Will my private health fund cover cosmetic surgery?

  • The surgery must be Medicare edible to be covered by private health insurance.
  • If you have plastic surgical item number exclusions, you will not be covered.
  • All health insurers should rebate some of your surgeon and anaesthetic fees if the above apply.
  • They will not cover all of these fees, there will still be an out of pocket component,
  • If you have hospital cover, your hospital fees should be covered, except for any co-payment that you may have agreed upon in your policy.
  • Once you have the correct item numbers, call your health fund and ask them to email you written approval before booking any surgery.
  • Your surgeon’s staff should also be able to help you through this confusing process.

What is an Item number?

  • Medicare carefully outlines what they deem eligible procedures and give each procedure an “Item number”.
  • This is a 5 digit number
  • If there is no Item Number, there is no Medicare eligibility or rebate.
  • Each Medicare Item number has a detailed description outlining the procedure covered and any fine print.
  • If the cosmetic surgery you are having does not exactly fit the description outlined by Medicare, your procedure will not be eligible.

My cosmetic surgery does not have an Item Number

  • If your surgery is not deemed Medicare eligible, it is then “ cosmetic”.
  • You will receive no rebates
  • Your private health insurance will not help towards any payments.
  • All non-eligible surgery must pay GST
  • Unfortunately Medicare pulled the abdominoplasty item number in 2017!

For clarification on your surgery, item numbers and eligible rebates etc, please call our experienced staff. We will help to demystify this convoluted and confusing quagmire created by the Australian Government.