If you’re considering cosmetic surgery, the cost is likely one of your primary concerns. Understanding whether your private health insurance can help cover some or all of the expenses is a crucial step in planning your procedure. Here’s what you need to know.

Does Your Insurance Cover Cosmetic Surgery?

Start by reviewing the terms and conditions of your health insurance policy. Most private health funds in Australia only cover procedures considered medically necessary for health reasons, such as reconstructive surgery. These procedures are typically referred by a medical professional.

If it’s not clear from your policy documents, the best way to confirm is to contact your insurer directly and ask about specific coverage for the procedure you’re considering.

Which Procedures Are Deemed Necessary?

Medically necessary procedures are often listed on the Medicare Benefits Schedule (MBS), an online catalogue of surgeries and treatments that are covered or subsidised by the Australian Government.

If your procedure has an MBS item number, it’s more likely that your private health insurance will contribute to the costs. Examples of commonly covered reconstructive surgeries include:

  • Cleft palate correction
  • Skin grafts
  • Scar revision treatments
  • Facial reconstruction surgery
  • Some breast surgeries, such as reconstruction after breast cancer

If your procedure is not listed on the MBS, it’s unlikely to be covered.

How Much Will Be Covered?

Coverage depends on your individual policy. Even if a procedure is covered, it’s possible that only part of the costs will be reimbursed. For example:

  • The surgeon’s fees might be covered, but you may need to pay for theatre costs, anaesthesia, or hospital stays out of pocket.

To maximise your benefits, check if your private health fund has agreements with specific hospitals or providers. Using a facility outside their network could increase your costs or void coverage entirely.

Special Circumstances and Exceptions

It’s always worth discussing your case with your health insurance provider. Special circumstances might allow for leniency or partial coverage. For instance, Mega Liposuction, offered at Cosmos Clinic, may be considered in some cases where excess weight poses a significant barrier to physical activity or quality of life.

Plan Your Next Step

If you’re considering cosmetic surgery, knowing your financial position is crucial. Start by checking your health insurance policy, and don’t hesitate to ask your provider detailed questions about your coverage. To learn more about the range of procedures offered at Cosmos Clinic, including Liposuction options, contact our team: