What does your insurance cover when it comes to plastic surgery? We have already reported that some private health insurers are rejecting claims when it comes to any plastic surgery, even approved reconstructive surgery, see this article.
There has always been some confusion between Reconstructive Surgery and Cosmetic Plastic Surgery. The term “Plastic Surgery” can actually refer to both of these, but they are very different things. Reconstructive plastic surgery refers to an operation or procedure undertaken to fix abnormalities, deformities, defects, burns, laceration or scar repair, physical effects from disease or trauma or repair normal bodily function. The majority of these are “necessary” surgeries to give the patient a quality or comfort of life they may not have had otherwise. Cosmetic Plastic Surgery, on the other hand, is an operation, treatment or procedure to enhance one’s appearance where no previous issue exists. Herein lies the confusion when it comes to what is and is not covered by insurance. What one person or doctor may see as a “problem” may be seen as purely aesthetical by the insurance company.
Medicare tends to cover most Reconstructive Surgery, even if it is only through the public hospital system which may involve long waits. However, many insurance policies have tight restrictions or exclusions on any plastic surgery. As there are over 1600 plastic and reconstructive surgical procedures in the Medicare Schedule you really want to be clear on what you are covered for. Even if you think you are covered for a specific procedure, identify if this means public or private hospital cover, before and/or after surgery care and any other associated costs. Also, keep in mind many insurance companies do not cover any plastic surgery procedure if it is seen as a “pre-existing” condition, so they have a clause specifying no cover for any procedure within a 12 month period of becoming covered. As each insurer is different, make sure you approach your insurer directly and be specific about inclusions and exclusions.
It is great that the Australian Government is becoming more aware of the need for more regulation in the area of plastic surgery and insurance, however as the insurance companies are still catching up when it comes to the demand in today’s age for plastic surgery, it is up to you to be diligent and specific when it comes to exactly what you are being covered for.