Cosmetic surgery is often sought to improve the appearance of a physical trait, such as a resculpting a misshaped nose, lifting droopy eyelids that come with age, or to increase breast size.
When cosmetic procedures -- both the surgical and non-surgical kind -- are done strictly to improve one's appearance, Australia's Medicare coverage does not cover them and your health insurance plan probably does not cover them either.
Reconstructive surgery coverage can be purchased through private health insurance providers, although it is important to compare health plans carefully to determine what restrictions and waiting periods may apply from one provider to the next.
Unlike cosmetic surgery, which is usually done to improve one's appearance, reconstructive surgery is performed when damage caused by a congenital abnormality, disease, or injury requires one or more surgical treatments to correct.
Under certain circumstances, reconstructive surgery becomes a necessary procedure (whereas cosmetic surgery is considered an elective procedure).
Some of the most common reproductive surgeries include: • Correction of a cleft lip or palate • Breast reduction • Breast reconstruction • Facial bone fracture repair • Skin grafting • Scar or laceration repair • Repair after tumor or growth removal Sometimes a procedure that is typically considered cosmetic, or elective, becomes reconstructive and therefore medically necessary.
Drooping eyelids, for instance, can interfere with vision and an eyelid "lift" may be necessary to correct the problem.
A rhinoplasty (nose job) is no longer considered a cosmetic procedure when it is necessary to correct a deviated septum or correct another medical problem.
Your health insurance policy may or may not cover reconstructive eyelid or nose surgery, which is why it is important to examine your policy carefully before scheduling any procedures to be sure it is covered.
With the exception of surgeries performed for cosmetic purposes, Medicare will cover the out-of-hospital costs for physician and specialist consultation fees, most treatments and procedures that must be performed by a physician, and certain items specifically identified under the Cleft Lip and Palate Scheme.
Patients needing reconstructive surgery that falls into the medically necessary categories, who receive a referral from a general practitioner (GP) or specialist, may be eligible for a Medicare rebate on the consultation fee.
Your health insurance provider may also offer a rebate in addition to Medicare, depending on the terms of your private insurance plan.
You should be aware of any potential out-of pocket-expenses not covered by your health insurance policy before scheduling any procedures.
When comparing health plans, check each provider's terms for out of pocket expenses in addition to waiting periods and procedures covered.
Depending on your financial situation, you may want to opt for more comprehensive coverage up front and avoid being surprised by unexpected out of pocket expenses if the need for a reconstructive procedure arises.
Of course, some providers or health plans exclude or restrict reconstructive surgery benefits, and your health insurance policy may not cover any type of reconstructive procedure.
This is why it is so important to compare private health plans to determine which will cover your surgery if you have a disfigurement due to an accident, illness, or medical condition.
Even policies that cover reconstructive surgery won't necessarily cover all procedures available.
Check with your provider to clarify which procedures are covered and which are not.
While some health plans provide full cover on most hospital admissions (with the exception of a co pay or any excess you agreed to when you purchased your policy,) other plans exclude or restrict benefits related to any one of the1600 surgical procedures defined in Medicare's plastic and reconstructive surgery category.
The level of payment provided by your health insurer will depend on the level of coverage you pay for, with lower premiums usually translating to lowered benefit payments.
These are the details that should be considered when comparing health policies before you purchase in order to secure the level of coverage that suits your needs.
Keep in mind, reconstructive surgical procedures can become clinically necessary at any life stage.
There is no way of knowing what services we may need or when the need might arise.
If your health insurance plan includes reconstructive surgery with restrictions, or excludes it altogether and the need for a procedure arises, you will be faced with the choice of upgrading your plan and abiding by the 12 month waiting period required to have the procedure done, or paying out of pocket for the entire cost.
Examine your health insurance plan once a year to be sure any restrictions or exclusions contained within it are still suitable for your health care needs, and the needs of your family.
If you decide you would like more comprehensive coverage for reconstructive surgery, compare medical plans to find the best cover for your needs.