Am I Covered For Surgery Or Not?

​Many plastic surgery patients and prospective patients are unaware that Medicare and Private Health Insurance companies may cover some procedures. 

​This particularly applies to breast surgery where some procedures that are considered by many people to be purely cosmetic do attract a Medicare item number.  

Most private insurance companies will partially fund surgery for which there is an applicable Medicare item number.  Not all private health insurance companies however do this and patients who have private health insurance should check with their funds to confirm whether all procedures that attract a Medicare Item Number are automatically covered. 

One of the commonest questions asked in Plastic Surgery Forums is whether or not surgery for addressing aesthetic and functional problems in the breasts are covered by Medicare.  Procedures such as breast reduction, where patients are troubled by symptoms related to the size of their breasts, do attract a Medicare Item Number and are partly covered by Medicare and Private Health Insurance companies.  Other procedures such as breast lift (mastopexy) may also be covered in certain circumstances, particularly if there are symptoms related to the sagging that occurs after pregnancy and breast feeding.  Other procedure such as breast augmentation for significant size mismatch between the breasts or for management of genetic abnormalities in the breast such as tuberous or constricted breasts also attract Medicare Item Numbers and most funds will therefore cover the costs associated with the hospital stay and theatre fees. 

What many patients seeking budget surgery overseas do not realize is that if there is a Medicare Item Number and they have private health insurance which covers these procedures, the surgery may in fact be cheaper in Australia than overseas where after care is almost universally inadequate.  Complications from surgery may also be covered if they occur in surgery arising where a Medicare Item Number applies and the surgery has been performed in Australia. 

Prospective patients should discuss their breast related symptoms with their plastic surgeon to determine whether or not rebates apply and any patients considering surgery overseas should ensure that the procedures they are seeking are not covered in Australia before considering taking the risks associated with surgery in foreign countries. 

Where Medicare rebates do apply a referral from a General Practitioner is required prior to review by a Specialist Plastic Surgeon.  For further information, contact the Australian Society of Plastic Surgeons or Dr Mark Hanikeri; www.markhanikeri.com