Costs involved in aesthetic surgery and when is it covered by health insurance?

Dr Michael YunaevUncategorized0

One of the very first questions that people ask when planning a cosmetic surgery is around the costs associated with it. “How much does it cost?” and “What are the out-of-pocket fees?” are amongst the top questions we receive at Breast & Body Clinic.

Cosmetic surgery costings involve a range of factors, including fees of highly skilled medical professionals, the use of advanced equipment and tools, and immaculate medical facilities, which are all vital to achieve the best results. The costs are also dependable on the patient’s individual needs; therefore, setting a generic surgical cost is very unrealistic, as costs do vary from operation to operation

At Breast & Body Clinic, a precise surgical quote is given to each patient after consultation with Dr Michael Yunaev, once the patient needs have been fully assessed. Based on this assessment, the patient will be provided with an individual and personalised surgical quote.

cosmetic surgery insurance

It is important to point out that regardless of the surgical procedure you are considering, your chosen surgeon should provide you with information around all costs involved in your surgery before you go ahead with it (so you don’t receive surprise bills down the track).

 

A comprehensive surgical costs pack should include:

• Initial consultation fees

• Pre-op and post-op consultations

• Surgeon’s fee

• Implant costs (in case implants are being used in the procedure)

• Hospital fees

• Anaesthetist fees

• Post-operative garments

 

“What are the out-of-pocket fees?”

surgery insuranceThe other very popular question that we get asked is “What are the out-of-pocket fees?”.

As aesthetic surgery grows ever more popular amongst Australians, people are also naturally asking what procedures, if any, are covered by Medicare and/or their private health insurance. On this question, there is both good and bad news.

The good news is that there certainly are surgeries for which you can claim a benefit.

However, to do so, you will need to have an underlying medical reason. Such procedures are termed reconstructive plastic surgery – as opposed to cosmetic (or elective) plastic surgery – and include:

  • Reconstruction procedures in cancer survivors, such as breast reconstruction
  • Breast reduction procedures, where there is a primary medical or functional reason, which includes back pain, shoulder and neck pain (Item no. 45520)
  • Breast Lift after pregnancy – Youngest child must be between 1-7 years old (Item no. 45558)
  • Tubular breast reconstruction (Item no. 45559)
  • Abdominoplasty (Item no. 30177)
  • Breast augmentation for asymmetry, where the asymmetry is significant and the augmentation is limited to 1 breast (Item no. 45524)
  • Breast Implants for breast deformity (Item no. 45528)
  • Breast Lift for Asymmetry (Item no. 45556)
  • Mastectomy for gynecomastia, with or without liposuction (Item no. 31525)

To find out whether a procedure you are considering is covered by Medicare or your insurer, you need to first check if it has a Medicare Benefit Schedule (MBS) number, which you can visit the Medicare website on http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Home

The next step is to ascertain whether you are eligible for a benefit under your specific coverage plan, if you have health insurance. This is important as some patients may have elected at the time of applying for their health insurance to forgo plastic surgery coverage in order to reduce their premium, not realising that reconstructive surgery falls under this umbrella.

If you are eligible, you then need to find out how much of the cost will be contributed by your insurer. Finally, if you are having your procedure done in a hospital, you’ll need to make sure your insurer has a coverage agreement with that hospital.

Depending on your cover, you may have to pay an excess or co-payment for your procedure. Importantly, as many reconstructive procedures are designed to correct conditions we cannot foresee (with the exception of congenital abnormalities), you should carefully consider the benefits of including plastic surgery coverage at the time of applying for or renewing your health insurance.

It is true that exempting such coverage may well lower your premium, however, you will be left with large medical bills should the unexpected happen and you subsequently require reconstructive surgery. The decision is ultimately up to you, but make sure it is an informed and carefully considered one.

It’s important to note that if your surgery is eligible for a Medicare rebate, in order to claim it you will need to see your GP first and to get a referral to the surgeon of your choice.

Of course, the bad news is that elective cosmetic procedures, which are performed without a medical need, are not covered by Medicare or private health insurers. For these, you will need to pay the full costs.

However, on the positive note, there are a number of financing companies in Australia that offer patients financing options to fund surgical procedures. At Breast & Body Clinic, we can assist you with this process.


If you would like to inquire about a cosmetic surgery procedure, please contact us here.

About Dr Michael Yunaev

Dr Michael Yunaev is an Oncoplastic Breast, General and Cosmetic Surgeon and is the Principal Doctor at Breast & Body Clinic. Dr Yunaev is a highly trained Surgeon with extensive experience and passion for the treatment of all aspects of Breast Cancer Surgery, Benign and Congenital Breast Disease and Aesthetic Breast Surgery, as well as General Surgery.

 

With locations in east and inner west Sydney and in the Southern Highlands, those searching for cosmetic surgery is simpler than ever. We have conveniently located clinics in:

• Potts Point
• Bella Vista
• Camperdown
• Rozelle
• Bowral