Will medicare cover Skin Reduction After Weight Loss: Arms, Tummy Tuck
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Will Medicare cover Abdominoplasty and Skin Reduction Surgery?

Posted on: September 28th, 2018
will-Medicare-cover-abdominoplasty-surgery-after-weight-loss

Medicare Benefits Schedule (MBS) Item Codes, Definitions and Criteria for Plastic Surgery are changed in November 2018.

These Medicare changes may have affect your rebate eligibility for skin reduction surgery after weight loss or Bariatric Surgery: including Brachioplasty, Abdominoplasty or Belt Lipectomy. Revision Rhinoplasty patients may also be impacted.

medicare-changes-plastic-surgery-november-2018-2019

A few years ago, the government made changes to the MBS in relation to post-pregnancy Abdominoplasty. It was no longer covered by an MBS item code although post-weight loss skin reduction NOT related to pregnancy, and for patients meeting strict criteria about body mass changes and skin reduction needs, remained on the MBS.

Medically Indicated Plastic Surgery and MBS rebate changes

  • Cosmetic surgery patients will NOT be impacted by these MBS changes.
  • That’s because cosmetic surgery is NOT covered by Medicare.
  • Nor is most Cosmetic Plastic Surgery covered by private Health Insurance Companies such as BUPA, AIH, Australian Unity, NIB and other recognised Australian health funds.
  • However, some Plastic Surgery procedures are corrective or restorative in nature, such as skin reduction after Bariatric Surgery or lifestyle changes resulting in significant skin folds after attaining weight loss.
  • These usually have an MBS item code and often have some hospital coverage DEPENDING on your HEALTH INSURANCE PLAN.

Many surgeries performed by Plastic Surgeons are medically indicated CORRECTIVE and RECONSTRUCTIVE Plastic Surgery.

They may have some aesthetic benefits, but they are performed for reconstructive purposes, such as to restore natural contours or reduce skin infections, back pain and neck pain caused by excess skin folds or redundant heavy tissue weight.

  • Specialist Plastic Surgeons usually perform both COSMETIC and/or CORRECTIVE/RECONSTRUCTIVE Plastic Surgery.
  • A purely Cosmetic procedure might be liposuction of the thighs, a facelift or a breast augmentation.
  • A Corrective Plastic Surgery procedure might be skin reduction of excess skin folds post-obesity (arms, stomach, thighs), breast reduction to reduce back pain/neck pain and shoulder pain, corrective Rhinoplasty/Septoplasty, Eyelid Surgery for severe ptosis, Breast Lift for ptosis after pregnancy or weight loss, and other similar procedures.

These MBS items may be changing on 1 November 2018 – if you were previously covered, you may no longer be eligible.

Note that your Private HEALTH FUND policy such as BUPA, AIH and Australian Unity can change too.

Changes are also occurring to Health Fund Policy Classifications and Private Health Coverage for surgery in terms of redefining classifications so that consumers better understand their policies, exclusions and coverage.

The Government is seeking to ensure consumers actually UNDERSTAND what they’re buying and what is and isn’t covered, as current policies are confusing for consumers and exclusion clauses are difficult to understand, leaving many patients unexpectedly NOT covered for medical warranted procedures.

November 2018 MBS Updates to Plastic Surgery criteria – Media Releases.

Changes to the MBS in the 2018-2019 Budget are NOT limited to Plastic Surgery operations. These changes include other areas of medicine, imaging/testing, and various forms of surgery.

Download the Medicare Health Insurance Guide

Medicare and Health Insurance Guide

For an Australian Government/Department of Human Services NEWS RELEASE regarding 2018-2019 budget MBS Review changes, effective 1 November 2018, click here.

Plastic Surgery and Medicare News & Media (Australia)

Plastic Surgery procedures by genuine Plastic Surgeons are being impacted according to a news release by the Australian Plastic Surgery Association (ASAPS).

Breast Reduction Surgery Patients, Breast Lift Patients, Removal & Replacement of Breast Implants, and Skin Reduction Lipectomy/Abdominoplasty Patients MAY likely be impacted by changing MBS criteria from the MBS Review team.

How MBS definition and criteria changes MAY impact you, as a Plastic Surgery patient.

  • If your MBS item code is removed or changed in a way you no longer meet criteria, then your private health insurance company is also not likely to cover your hospital or surgery costs; as health insurance policies usually cover only procedures that are on the MBS list.

medicare-abdominoplasty-for-after-obesity-surgery.

Is my Plastic Surgery for Skin Reduction or Abdominoplasty/Belt Lipectomy after weight loss  covered after changes to the Medicare Benefits Scheme (MBS) on 1 November 2018?

  • If your MBS Item Code is changed and your condition or surgery no longer meets the criteria, you may become ineligible for a rebate.
  • Check the latest MBS publication releases occurring in October 2018 and phone your doctor, Surgeon and/or insurance company if any questions.
  • Post-weight loss patients meeting strict criteria – including weight loss NOT related to pregnancy – may still have some rebate eligibility for skin reduction after bariatric surgery, for example, but post-pregnancy conditions typically do not meet criteria.
  •  Read the ASAPS Media Statement on MBS Item removal for Abdominoplasty and how it helps women after having children.
  • In a Budget review of health care expenses, the Medicare Benefits Schedule Taskforce and MBS Review TEAM changed criteria descriptions and Medicate ITEM codes (see the 2018-2019 Budget release).

The result:

Changes to the Medicare Rebate Schedule (MBS) – that went into effect on 1 November 2018 – IMPACTED several Plastic Surgery operations even though they are corrective, restorative, reconstructive and/or otherwise medically necessary versus cosmetic in nature.

MBS review and Medicare criteria changes for Plastic Surgery operations can potentially impact:

 

Download the excess skin reduction guide

Skin Reduction Guide Download

Results: Some reconstructive Plastic patients will be left with higher out of pocket surgery costs.

Private Health Fund Hospital/Surgery Cover and Medicare Item Codes – How BUPA, AIH and Australian Unity are also impacted by these changes

Potential impact of changes to MBS for reconstructive, restorative or corrective Plastic Surgery:

  • higher surgery costs to patients / less rebate eligibility (estimated)
  • more visits and reports to other medical professionals (more extensive paperwork and image submissions)
  • some conditions may no longer be eligible and NO Medicare code may apply; this means your Private Health Fund will ALSO not cover your operation costs.
  • NO coverage for multiple surgeries in one operation session – surgeries will need to be more sequenced rather than combined

Note this information may change as more NEWS RELEASES arise in relation to the Medicare Schedule changes.

Further research  and Media Releases – Plastic Surgery: Medicare and Health Insurance

Subsidising Tummy Tuck Surgery – Calls for Plastic Surgery Cost Assistance for women after having children

The Australian Society of Plastic Surgeons (ASAPS) also released a statement about November 2018 Medicare criteria changes for Plastic Surgery procedures.

ASAPS Media Release about Abdominoplasty MBS Item Code Removal and Women’s Health Outcomes and Surgery Costs

Abdominoplasty Improves Low Back Pain and Urinary Incontinence

Authors: Taylor, D. Alastair, F.R.A.C.S.(Plast.); Merten, Steven L., F.R.A.C.S.(Plast.); Sandercoe, Gavin D., F.R.A.C.S.(Plast.); Gahankari, Dilip, F.R.C.S.(Ed.), F.R.A.C.S.(Plast.); Ingram, Scott B., F.R.A.C.S.(Plast.); Moncrieff, Nicholas J., F.R.A.C.S.(Plast.); Ho, Kevin, F.R.A.C.S.(Plast.); Sellars, Graham D., F.R.A.C.S.(Plast.); Magnusson, Mark R., F.R.A.C.S.(Plast.)

Source: Plastic and Reconstructive Surgery: March 2018 – Volume 141 – Issue 3 – p 637–645   DOI: 10.1097/PRS.0000000000004100   Cosmetic: Original Articles

Source link: https://journals.lww.com/plasreconsurg/Abstract/2018/03000/Abdominoplasty_Improves_Low_Back_Pain_and_Urinary.13.aspx

https://ama.com.au/ausmed/tummy-tuck-can-ease-back-pain-incontinence-study

https://www.theaustralian.com.au/news/latest-news/tummy-tuck-eases-postbirth-back-pain/news-story/fc3abcd1ac51fbb2dfe5f8d4c6e1dbd7

https://www.plasticsurgeryhub.com.au/what-are-the-changes-to-the-medicare-funding-for-tummy-tuck-abdominoplasty/