Is cosmetic surgery covered by private health insurance?

But it can rack up a considerable hospital bill, even if it’s medically necessary.

However, private health insurance can help offset the expense.

What is cosmetic surgery?

Speaking to news.com.au, British plastic surgeon and the President of The Australasian College of Cosmetic Surgery and Medicine, Dr Patrick Tansley says cosmetic surgery covers operations that “essentially enhance appearance”.

Although this can include plastic surgery that alters or reconstructs aspects of your face and body (like breast and face lifts or liposuction), skin rejuvenation procedures like Botox and laser resurfacing also fall under this category.

Blepharoplasty – an operation that repairs drooping eyelids – is not covered by Medicare or private health unless it’s to correct vision loss. Picture: iStock.Source:istock

What’s the difference between cosmetic surgery and reconstructive surgery?

While both are executed by plastic surgeons, the difference between cosmetic and reconstructive surgery comes to the operation’s “functional benefit”, says Dr Tansley. Reconstructive surgeries refer to procedures that correct lacerations or scars, congenital abnormalities and also include surgery following burns, traumatic injuries or the removal of cancers or tumours.

“A breast augmentation or a facelift enhances appearance – it doesn’t have a functional component,” he says.

“However, with something like a traumatic injury to our hand, reconstruction of the hand gives it functional benefits. Similarly, if a patient has a burn they may need reconstruction on that burn.”

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Can cosmetic surgery be covered by Medicare?

Although no insurer covers a cosmetic surgical procedure in their own right, a procedure which offers both an aesthetic and functional benefit may be partly covered by Medicare. This depends on whether the surgery is on the Medicare Benefits Schedule (MBS), says Dr Tansley.

For example, although abdominoplasty (also known as tummy tuck) can be classified as a cosmetic procedure which reduces the appearance of excess skin, it’s also deemed as a way to prevent skin infections. Similarly rhinoplasty – a surgery which changes the shape of the nose – can also be recommended to treat airway obstructions.

To see if your health concern may qualify for a surgery that’s on the MBS, you’d first need to visit your GP, who would refer you to the appropriate surgeon for a consult.

Rhinoplasty procedures may be partly covered by Medicare. Picture: iStock.Source:istock

Is plastic surgery covered by private health insurance?

In addition to potential Medicare cover, your private health insurance may also subsidise part of your treatment, depending on your policy.

Just keep in mind that private health insurers are not required to subsidise elective operations that aren’t medically necessary. Therefore, it’s important to check the terms and conditions of your policy before committing.

How much you’re able to claim will also depend on your specific health fund and whether any waiting periods apply.

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How do I find a good cosmetic surgeon?

Given the expense, risk and invasive nature of cosmetic surgery, Dr Tansley recommends patients seek surgeons who are qualified and have training in the surgical area you’re seeking.

He also specifies that plastic surgeons are not automatically trained in cosmetic surgery, meaning “it’s very important” patients choose a surgeon who is “specifically trained in cosmetic surgery”.

Dr Tansley also recommends patients ask their surgeon the following questions as well:

1. How many of the specific surgical procedure have they done? While there isn’t a “specific number,” they should be able to demonstrate they’re trained and experienced in the procedure and “give some confidence to a patient”.

2. Can the surgeon show before and after images? Similarly, can you find patient reviews with positive experiences?

3. Ask questions to find out the nature of a surgeon’s practice. This includes whether they work in an accredited hospital, do they have an accredited anaesthetist, what are the qualifications of the staff they work with (like trained nurse assistants).

Dr Tansley says these questions will help gauge a surgeon’s experience and consider what might happen if complications arise.

“It’s very important to for a patient to appreciate that before they go forward for cosmetic surgery,” he said.

Getting a surgeon who is experienced in your chosen procedure is critical. Picture: iStock.Source:istock

How long do I have to wait before I can claim on plastic surgery?

This depends on your individual policy and the procedure you’re looking to claim on.

According to the Commonwealth Ombudsman, customers looking to upgrade their policy to include plastic and reconstructive procedures also face waiting periods. It states that if the treatment your require applies to a pre-existing condition, or for maternity services (obstetrics), you will have to wait for 12 months before you’re entitled to these services.