Monthly Archives

May 2022

Using Private Health Insurance for Plastic Surgery

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Plastic surgery includes a wide range of procedures, many of which are cosmetic. Medicare and private health insurers do not cover any of the costs associated with cosmetic surgery. Cosmetic surgery is surgery that is done to improve your appearance and has no specific health benefit eg breast augmentation to improve breast size. There are a large number of plastic surgery procedures which improve your appearance and also improve your health eg flap repair of a skin cancer defect. These procedures are often called “reconstructive surgery”.

If a procedure is covered by Medicare, it will also be covered by your health insurer, so long as reconstructive surgery is included in the policy. The issue many patients face is that the Medicare item numbers for body contouring surgery are not classified under the plastic surgery section of the Medicare benefits schedule. Many private health insurers will require their customers to take-out top-level cover if they are looking to have body contouring surgery after massive weight loss, such as plastic surgery for loose skin.

In Australia we have a private and public healthcare system. In the private health system, you will receive a Medicare rebate if your surgeon allocates a Medicare number to your procedure. Your surgeon can only allocate this Medicare number if your medical history and examination correlate with the Medicare description for that procedure. If you have Private health insurance, procedures covered by a Medicare number allow the insurer to also cover the cost of your theatre and accommodation at the hospital. Self-funded patients (people who do not have private health insurance) will still need to pay for their hospital stay.

If your procedure is “cosmetic” then it does not have a Medicare item number, for example face lift surgery. Health insurance does not cover the cost of cosmetic surgery, nor does it cover the cost of management of complications of cosmetic surgery.

Examples of Reconstructive/Cosmetic surgery include:

  • Surgery that repairs congenital abnormalities such as nasal deformities and cleft lips.
  • Surgery thar reverses the damage of traumatic injuries
  • Skin grafting for burn victims
  • Scar repair
  • Reconstruction that follows the removal of tumours like skin flap and breast reconstruction.

All these procedures have an item number in the Medicare Benefits Schedule, meaning Medicare and private health funds are likely to cover them. Although, some may require you to meet a specific criterion to receive plastic surgery. If a plastic surgery procedure doesn’t have a Medicare Benefits Schedule umber, it likely will not be covered by a health fund.

Exclusions and Restrictions

Although you may have coverage for some reconstructive surgeries, there are probably some hidden exclusions or restrictions you should know. Exclusions mean that your health fund won’t cover particular procedures, and restrictions mean that they will cover a portion of the cost, but the rest is up to you. It is important to be aware of these things, so you aren’t surprised with a high bill you didn’t expect.

The best way to check if you qualify for rebate from your surgery from Medicare or your health insurer is to have a consultation with us at Southern Aesthetic, so we can provide you with advice regarding which Medicare item numbers you can use.

Understanding the COVID19 Guidelines for Surgery

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Now that we are living with COVID-19 in our community, new guidelines have been released by the Agency of Clinical Innovation (ACI) to make surgery as safe as possible.

The ACI specified that:

“Decisions regarding surgical timing will require careful consideration of possible sequelae of COVID-19 infection, the urgency of the required surgery and the expected physiological effects of surgery and anaesthesia on the patient. After seven weeks, the perioperative risk is thought to return to baseline in those who had asymptomatic COVID-19 infection and/ or those whose symptoms have resolved.”

The current Australian and New South Wales (NSW) guidelines recommend that planned surgery in patients should be delayed until eight or more weeks after infection with COVID-19. The guidelines also mention that vaccination against COVID-19, at least two weeks prior to elective surgery, reduces the risk of preventable COVID-19 infection, and the severity of the infection in surgical patients.

So, how should you plan for surgery?

It is important to be diligent and careful prior to surgery because anyone who gets covid will have to avoid general anaesthetics for several weeks. Anyone who still has lingering chest problems after seven weeks should delay surgery even further. We are aware that patients who are unlucky enough to get covid right after surgery are more at risk of developing severe covid and its complications, so we recommend minimising your social outings during recovery time.

Your Action Plan:

It is vital to stay in touch with your surgeon in the preoperative period so that we can reschedule your operation if you do contract covid in the seven weeks prior to your date of surgery. We ask that our patients select their social outings carefully to minimise the risk of contracting the virus and to avoid delaying surgery.

Since we also want to protect our post-operative patients in the clinic, and our staff, we ask that if you have any cold and fly symptoms to change your appointment to a video or telephone consultation.

COVID-19 Safety at Southern Aesthetic

At Southern Aesthetic, we have put numerous safety measures in place to ensure your visit goes as smooth as possible. When you visit the office, you will be asked to check in and use hand sanitiser before completing a registration form with a clean pen. We ask that all patients come to their appointment alone if possible. We can organise for your supporting family or friends to participate in the consultation via speaker phone. You will be given a mask to wear during your time in the office for your own protection.

As the health system has adjusted to life with covid, we have had to evolve daily to safely provide the highest standards of care for all our patients. If you have any further questions regarding surgery and COVID-19, please call us at Southern Aesthetic Plastic Surgery, the plastic surgeon the Shire locals trust, on 02 9186 8105.