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Private health insurance can cover you for excess skin removal, but only if it is medically necessary. It's covered through hospital cover under "Plastic and reconstructive surgery (medically necessary)". That treatment category is included in all Silver policies and above, but also on a few Bronze Plus policies as well.
Clearing the 'medically necessary' bar will be different gor everyone. Start by talking to your GP and your insurance providers. That said, a few of the conditions you might need to meet include:
All hospital policies have waiting periods before you can make a claim. For excess skin removal, the standard waiting period is 2 months. However, a pre-existing condition will bump that waiting period up to 12 months. This is pretty common for excess skin removal, due to the nature of the condition.
Medicare will pay for 75% of the MBS costs if you receive treatment as a private patient in a private hospital. There are a few different Medicare item numbers associated with excess skin removal – all depend on the type of procedure you will receive. For example, 30177 is for a lipectomy.
Private health insurance will pay for the remaining 25% of the MBS fee. However, your surgeon will probably charge a lot more than the MBS fee, and you'll likely have an out of pocket fee. You insurer could have a no gap fee agreement with a hospital, but it's pretty uncommon for excess skin removal.
When you use private health insurance, you will often still have an out-of-pocket costs to pay.
The federal government's database, Medical Costs Finder says 94% of private abdominoplasty patients had an out of pocket fee, with the average cost being $7,500. It says the upper range of that gap can be as much as $12,000.
Knowing your out-of-pocket cost ahead of time can be hard - it's a known issue with private healthin Australia. The best approach is to call your private health insurer as soon as you get a GP referral. Then, before your surgery, have it confirm in writing what you'll be covered for.
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