How do I determine if my plastic surgery is medically necessary?

To determine if your plastic surgery is medically necessary you need a referral from your general practitioner to a specialist plastic surgeon. The surgeon will assess your condition and confirm if it meets specific criteria under the Medicare Benefits Schedule (MBS). These criteria often relate to physical impairment or significant functional issues. If the surgery qualifies, the surgeon will provide you with an MBS item number.

Are there waiting periods for medically necessary plastic surgery?

Yes, standard waiting periods apply for hospital cover, even for medically necessary plastic surgery. There is typically a 2 month waiting period for most hospital treatments. If the reconstructive surgery is for a pre existing condition you will generally need to serve a 12 month waiting period before your private health insurance will cover it.

Does private health insurance cover complications arising from cosmetic surgery?

No. If the initial cosmetic surgery was not medically necessary and therefore not covered by health insurance, then any complications that arise directly from that procedure are also unlikely to be covered by your private health insurance or Medicare. You would typically be responsible for the full cost of treating these complications.

What are Medicare item numbers and how do they apply to plastic surgery cover?

Medicare item numbers are unique codes assigned to specific medical services and procedures listed on the MBS. For plastic surgery to be deemed medically necessary and thus eligible for Medicare benefits and private health insurance cover, a specialist surgeon must determine that your procedure meets the specific criteria associated with an MBS item number. Without an eligible MBS item number, the procedure is considered cosmetic and will not receive any government or private health fund subsidies.

Can health insurance cover skin removal surgery after significant weight loss?

Yes, in specific situations. If excess skin after substantial weight loss causes ongoing functional problems such as skin irritation, rashes or infections and meets particular Medicare item number criteria for reconstructive surgery, your private hospital insurance may cover it. You will require a referral from your general practitioner to a specialist plastic surgeon for a thorough assessment.

Can I use my extras cover for any costs related to plastic surgery?

Extras cover typically applies to ancillary health services like physiotherapy, occupational therapy or psychology. If your medically necessary reconstructive surgery requires rehabilitation or post operative support these services might be partially covered by your extras policy depending on your level of cover and annual limits.