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Breast reduction insurance

Does health insurance cover breast reductions?

If you’re about to go under the knife for breast reduction surgery, it’s essential to know whether your private health insurer will help cover the cost of the procedure. Hospital cover policies cover surgical and accommodation costs for a wide range of procedures, but they will only pay a benefit for breast reduction surgery that is medically necessary, not for surgery conducted for cosmetic purposes.

Let’s take a closer look at what breast reduction surgery involves and how you can make a private health insurance claim.

Compare your cover options online or with help from an adviser

What cover is avaiable through private health insurance?

Private health insurance hospital cover is available in a range of levels to suit the cover needs and budgets of different people: public hospital cover, basic hospital cover, medium hospital cover and top hospital cover. While the exact list of treatments and procedures covered by these policies differ between insurers, you will need a top- or possibly mid-level policy in order to receive a benefit for breast reduction surgery.

However, in order to receive cover for the procedure, Medicare will need to deem it medically necessary. Breast reduction surgery conducted for purely cosmetic purposes isn’t covered by your health fund. There are also some funds that don’t offer any cover for breast reduction surgery.

You’ll need to check the specific terms and conditions of your health insurance policy to find out whether it’s possible to receive cover for the cost of the procedure. Your doctor will also need to provide information to support your claim and your eligibility for cover could depend on factors such as the amount of breast tissue to be removed.

Finally, it’s worth pointing out that any health problem that needs to be alleviated by breast reduction surgery will likely be classed as a pre-existing condition by your health fund, so you will need to serve a 12-month waiting period before you will be eligible to receive any benefits.

Signs that a breast reduction might be right for you

Medical reasons for breast reduction surgery include:

  • Back pain and backaches
  • Neck pain
  • Shoulder pain
  • Migraine headaches
  • Shortness of breath
  • Numbness in the hands and fingers
  • Skin irritations

If you suffer from any of the above symptoms, breast reduction surgery could be beneficial for you.

However, the procedure does come with a number of risks attached and it’s important that you’re aware of them before going under the knife.

How much does breast reduction surgery cost?

The cost of a breast reduction procedure varies according to the surgeon you choose and the hospital where the surgery is performed. You’ll need to consider the surgeon’s fees, anaesthetist's costs and hospital accommodation costs when calculating the total bill for the procedure, but the overall cost could be around $7,000.

If the procedure is medically necessary, Medicare will pay a benefit to cover some of the cost. For example, reduction mammaplasty with surgical repositioning of the nipple is benefit number 45520 on the Medicare Benefits Schedule (MBS), with a maximum benefit of $675.35 paid per breast.

What’s involved in breast reduction surgery?

Breast reduction surgery, which is also commonly referred to as reduction mammaplasty, involves cutting and removing excess fat and glandular tissue from the breast, repositioning the nipple and areola higher on the breast and removing the excess skin. This makes the breasts smaller and lighter. The aim of the surgery is to produce breasts of a size and shape that are in proportion to the rest of the patient’s body.

However, it’s worth pointing out that it is recommended that you wait until your breasts are fully developed and childbirth and breastfeeding have been completed before undergoing the procedure. Your ability to breastfeed following breast reduction surgery may be harmed and changes to your breasts while pregnant can also alter the results of previously completed surgery.

Making a claim

If you’re planning on undergoing breast reduction surgery and need to know whether you’ll be covered, you’ll first need to find out whether the procedure will be deemed medically necessary by Medicare and therefore eligible for a benefit.

You will also need to provide details of the procedure to your health fund to determine whether or not you are eligible for cover. This usually involves filling out a medical estimate form with information on your surgeon, anaesthetist, procedure (including MBS item numbers) and the hospital where you will be treated. Your fund will then be able to tell you whether or not you will be covered and to what level.

Frequently asked questions about breast reductions

Q. Will I be able to breastfeed a baby after undergoing breast reduction surgery?

  • A. There is no guarantee that you will be able to breastfeed after the procedure is completed.

Q. Will my breasts return to their previous size if I put on weight following breast reduction surgery?

  • A. This is highly unlikely, but putting on a significant amount of weight will cause your breasts to enlarge.

Q. Will I need anaesthesia to undergo breast reduction surgery?

  • A. Yes, the procedure is almost always done with the patient is under general anaesthesia.

Q. Will I have scarring after surgery?

  • A. Yes, scars are an inevitable result of this type of surgery. However, your surgeon will make every effort possible to minimise scarring.

Q. Will I be treated in hospital?

  • A. Yes, breast reduction surgery is an inpatient procedure. 

Compare your health insurance options

Details Features
High 65 / 75 / 85% - $0/$250/$500 Excess
High 65 / 75 / 85% - $0/$250/$500 Excess
Combines High Hospital Cover with its highest level of extras cover.
  • Cover starting from $44.74 weekly
  • 12 month waiting period for pregnancy
  • 65% back on extras
  • Choice of $0, $250 and $500 excess
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Premier Package
Premier Package
Top tier combined hospital and extras policy that covers you for an extensive range of hospital and general treatment services.
  • All the benefits of HCI's Premier Hospital policy
  • All the benefits of HCI's Premier Extras policy
  • Cover for pregnancy and IVF treatment
  • Cover for general and major dental
Get Quote More info
Deluxe flexi
Deluxe flexi
Deluxe flexi provides cover for a range of treatments including hip replacement, spinal fusion, dialysis and major eye surgery.
  • No excess for kids
  • All joint replacements
  • Major eye surgery
  • Rehabilitation
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GoldStar
GoldStar
Premium hospital cover with complete cover for hospital expenses. Save 4% when you pay for 12 months of your cover upfront.
  • All theatre fees covered
  • Unlimited maternity cover
  • Choose no excess or $200, $400, $500 per admission
Get Quote More info
Smart Combination
Smart Combination
Smart combination provides a high level of cover for both hospital and extras.
  • Claim up to $2725 back on extras
  • Hip and knee replacements
  • General and major dental
  • Physio
Enquire Now More info
Prestige
Prestige
Highest level of combined cover offered by CBHS. Includes the same benefits as Comprehensive Hospital and Top Extras plus more. Restricted fund: Only current or former staff (and their families) of Commonwealth Bank Group and their subsidiaries which include Aussie, Bankwest, Colonial First State and more can join.
  • No excess or co-payments on hospital cover
  • Non-student dependent under 25 can be kept on policy
  • Access to Chronic Disease Management Programs
  • Widest range of extras including orthodontics
Enquire Now More info
Bronze Hospital (no pregnancy) and Bronze Extras Set Benefits
Bronze Hospital (no pregnancy) and Bronze Extras Set Benefits
High level of hospital cover and extras cover for a range of popular services including knee and should reconstructions.
  • Most comprehensive hospital options
  • Cover for general and major dental
  • Shared or single room in a private hospital
  • Intensive and coronary care
Enquire Now More info
Premium Hospital and Silver Extras Cover
Premium Hospital and Silver Extras Cover
Comprehensive hospital cover including pregnancy cover. Also included affordable mid-level extras cover for dental, optical and therapies.
  • Cover from $39.50 per week
  • Pregnancy and birth-related services cover
  • Heart surgery cover
  • 100% cash back on two dental check per year
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Top Hospital with Top Extras
Top Hospital with Top Extras
Get comprehensive hospital and extras cover and tailor your policy to your needs.
  • Pregnancy and birth services cover
  • Back surgery cover
  • $1000 general dental annual limit
  • $600 physiotherapy annual limit
Enquire Now More info
Young Couples Combined Cover
Young Couples Combined Cover
Mid-level hospital and basic level Extras package with an excess for young, healthy couples that are not quite ready to start a family.
  • Emergency ambulance cover
  • Cancer-related surgery cover
  • 70% back on extras
  • $300 dental annual limit per person
Enquire Now More info
Picture: Shutterstock

Richard Laycock

Richard is the senior insurance writer at finder.com.au and is on a mission to make insurance easier to understand.

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