Can Private Health Insurance Contribute?
Private health insurance generally does not pay benefits for an operation undertaken solely for cosmetic reasons.
In selected medically indicated cases, hospital insurance may contribute where:
- An eligible MBS item applies
- The relevant clinical category is included in the patient’s hospital policy
- Waiting periods have been completed
- The procedure is not excluded or restricted
- The proposed hospital has appropriate arrangements with the insurer
- The insurer’s other requirements are met
Private health insurance policies differ. A patient with hospital cover should not assume that buttock reshaping fees will be covered.
After assessment, the practice may provide the proposed MBS item number where one is applicable. The patient can then contact their insurer and ask:
- Is this MBS item covered under my policy?
- Is medically necessary plastic and reconstructive surgery included?
- Have I completed the relevant waiting period?
- Does my policy have exclusions or restricted benefits?
- Is the proposed hospital covered?
- What excess or co-payment will apply?
- Are there expected gaps for the surgeon or anaesthetist?
- Do I need written pre-approval?
Patients should seek written confirmation from their insurer before making financial decisions. The practice cannot guarantee how an insurer will classify or pay a claim.