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Compare Private Health Insurance for Cosmetic Surgery

Sally Aquire January 23rd, 2012 0 comments
Health insurance

Assuming that it is done purely for vanity reasons, cosmetic surgery isn’t available on Medicare and because of this, private health funds typically don’t pay benefits for these types of procedure. This is also the case for non-surgical cosmetic procedures. Reconstructive surgery is much more readily available through private health insurance, although some policies may also restrict or exclude this cover.

Image by Walt Stoneburner

What is Reconstructive Surgery?

Whereas cosmetic surgery is often done to improve the appearance, reconstructive surgery is performed to correct abnormalities and damage caused by trauma and is an essential procedure (rather than an elective one). Some common types of reconstructive surgery include:

  • Breast reconstruction
  • Breast reduction
  • Cleft lip palate
  • Skin grafting
  • Repair of facial bone fractures

In some cases, a procedure which would otherwise be considered cosmetic may be needed as reconstructive surgery. For example, if drooping eyelids are causing vision problems, eyelid surgery may be necessary to correct the problem.

What is Covered?

Medicare covers out-of-hospital services such as consultation fees for doctors (including specialists), most surgical procedures that are performed by doctors, and specified items under the Cleft Lip and Palate Scheme, except for when the surgery is not clinically necessary, i.e. it is solely for cosmetic reasons.

If your surgery is purely reconstructive (and not for cosmetic purposes) and you have a referral from a GP or specialist, you may be able to get some of the costs covered as a rebate from Medicare for the consultation fee and if the procedure also has an item number you may also be able to receive a rebate through your private health insurance. Check to see whether this is the case for you.

There may be out-of-pocket expenses that aren’t covered by your policy but these should be made obvious to you during the consultation when costs are discussed.

Restrictions and Exclusions

Some health insurance policies restrict or exclude benefits for reconstructive surgery as well as for cosmetic surgery, which means that you may not be covered at all for these type of surgery or you may only have a very low level of coverage for necessary procedures.

When you’re looking to compare private health insurance for cosmetic surgery, remember that only reconstructive surgery is usually available through private health insurance. If you’re thinking about having cosmetic surgery such as breast implants or a face lift, you won’t be able to do this through your private health insurance so you’ll need to have alternative arrangements in place to cover this.

While reconstructive surgery will be covered by many health funds, it may be restricted or completely excluded on some policies, which is something to think about when you’re trying to compare health insurance for cosmetic or reconstructive surgery. Even if your policy does cover reconstructive surgery, don’t assume that all reconstructive procedures will necessarily be included in the coverage. Check with your health fund to confirm which procedures are definitely covered as there may be some that aren’t.

Disclaimer: The above information is correct and current at the time of publication.

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