Guides

Will Your Medical Insurance Cover Cosmetic Surgery?

Close-up of female face being measured by plastic surgery doctor

You want to have cosmetic surgery, but can you afford it? What’s more, does your private health fund cover all of or any of your desired operation? A significant consideration when it comes to cosmetic surgery is the expense. Knowing where you stand financially is one of the first things you should work out. Here’s how.

Check your cover

First off, check the terms and conditions of your insurance. Your policy documents will list included procedures. If the information isn’t that obvious, the general rule of thumb is that a procedure must be deemed ‘necessary’ for health reasons and referred to as reconstructive surgery.

Which surgeries are ‘necessary’? 

The Medicare Benefits Schedule or MBS is an online list of all the surgeries and treatments that are covered or subsidised by the Australian Government. If your desired procedure is not on the MBS list and has no Medicare Item Number, it’s unlikely that a private provider will pay out. However, if the process is listed, you can ask your private provider to contribute to the costs.

Examples of reconstructive and therefore covered surgeries include cleft palate, skin grafts, scar treatment, facial reconstruction and some necessary breast surgeries. For instance, if a lady has breast cancer and needs breast reconstruction involving implants.

How much will be covered?

Again, this is very much down to your policy and terms. Some conditions or treatments are deemed elective and therefore only partially covered by insurance, in which case the onus is on you to make up the difference. The terms of your coverage might, for example, state that they will cover the surgeon’s fees but not the costs of the theatre or other staff in attendance.

When enquiring, make sure to ask if your Private Health Fund has a contractual relationship with a hospital. Going elsewhere could void coverage or increase personal cost.

Special cases and circumstances

It’s always worth speaking to your provider in case of leniency or exceptional circumstances that might affect your ability to claim. For instance, mega liposuction, as offered at Cosmos Clinic, can remove up to 15 litres of fat. This procedure is a health requirement for patients who are morbidly obese. While it immediately shifts weight, it also places patients on the right track to start a new, healthy lifestyle including the ability to exercise which might previously have been impossible or too painful to consider.

Contact our friendly staff to find out more about the range of liposuction procedures and other surgeries at Cosmos Clinic.