Good news! For post weight loss patients, it is possible to get a tummy tuck Medicare rebate in Newcastle. If you have been struggling with extra skin and/or muscle separation after significant weight loss, it can be a relief to know you can get a little financial help.
There aren’t any public hospitals that offer free cosmetic surgery in Newcastle. Medicare and most private insurances do not cover abdominoplasty. However, you may be eligible for a small Medicare rebate if you qualify for the weight loss criteria that started back in 2016.
There are specific Medicare item numbers depending on your medical conditions, weight loss, symptoms, and other factors. These allow you to get a rebate from the hospital or private health fund for weight loss only. Of course, the rebate will not cover the entire cost. However, it can make life a little easier financially. There will still be costs you will need to pay out of pocket. This can include the surgeon fee and anesthetic fee, for example.
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Changes to the Medicare item number for abdominoplasty
In 2016, the federal Government reinstated the Medicare item number for extreme weight loss patients. The MBS code for abdominoplasty had been removed. Naturally, there was a lot of backlash from women’s health groups who rightly believe post-pregnancy tummy tucks should be covered as well. The fight continues. In the meantime, the MBS codes only apply to tummy tucks for patients who have lost weight not due to pregnancy.
If you are post massive weight loss, it can take thousands off your bill if you qualify for the codes.
Here are 5 ways to get the rebates that are available to you:
Nr 1: Obtain Medicare coverage
Having Medicare coverage is needed to get health fund coverage. You should also review your health care policy to see if you are covered for cosmetic surgery procedures.
Nr 2: Demonstrate significant weight loss and stay at a steady weight
Significant weight loss is defined as at least 5 BMI points. This drop in weight must be unrelated to pregnancy, as far as the rules currently stand. For men and women who have undergone weight loss of 15kgs or more, this can be your golden ticket.
Another caveat is that you must not have had weight fluctuations for six months at minimum. Of course, a modest couple of pounds is acceptable. But overall, your weight should be steady during that time.
Nr 3: You have excess skin that is disrupting your daily life
Patients who have lost a lot of weight usually have excess skin. It can be hard to clean between the folds. Sweat and bacteria can accumulate, leading to infections and skin rashes. Chafing as the skin rubs against itself can results in painful sores, redness, and irritation. If these skin folds are causing problems in your activities of daily living, you may qualify for a rebate.
However, it is not as simple as it sounds. You must be able to show that you have tried other conventional non-surgical remedies to get rid of skin irritation for at least three months. If after that time, those treatments have failed to work, you may be eligible for a rebate.
Nr 4: Hernias
Hernias are painful. They are caused by a tear in the deeper layers of your abdominal wall. If you are a patient who has had a hernia that has been documented with an ultrasound, that may also help you in seeking coverage.
Nr 5: Talk to your doctor
When in doubt, ask your physician what is covered. You can discuss all of the above, and ask what other ways you might qualify for Your referring doctor is the first stop when asking questions, and your plastic surgeon will also usually be able to help guide you. Providing a referral to Dr. Beldholm may allow you to get a small rebate as well.
Download your Post Weight Loss GP Referral Form
So, what is the MBS Schedule?
The Medicare Benefits Schedule is Australia’s universal health care program, or Medicare. It covers some of the cost of a procedure for some patients. The MBS Schedule has item numbers that you may qualify for in order to get a rebate. There are currently no item numbers that pertain to post-pregnancy conditions for tummy tuck surgery. These codes are for weight loss only.
Item numbers for tummy tuck surgery and what they mean
Lipectomy, wedge excision of abdominal apron that is a direct consequence of significant weight loss.
If you are post weight loss and you have skin hanging over your lower abdomen “like an apron” then this item number would apply to you.
Lipectomy, wedge excision of redundant non abdominal skin and fat that is a direct consequence of significant weight loss. Where the procedure involves 1 excision only.
This item number is used for other areas such as arms, legs and other skin areas.
Lipectomy, wedge excision of redundant non abdominal skin and fat that is a direct consequence of significant weight loss. Where the procedure involves 2 excisions only.
This item number is used for an inner thigh lift or an arm lift.
Lipectomy, excision of skin and subcutaneous tissue associated with redundant abdominal skin and fat that is a direct consequence of significant weight loss, in conjunction with a radical abdominoplasty (Pitanguy type or similar), with or without repair of musculoaponeurotic layer and transposition of umbilicus.
This is the Item number is for a full tummy tuck or an extended tummy tuck.
Circumferential lipectomy, as an independent procedure, to correct circumferential excess of redundant skin and fat that’s a direct consequence of significant weight loss.
This item number is used for a body lift.
What are the basic requirements for these MBS numbers?
Each item number has its own descriptor and requirements. However all item numbers have the following criteria in common:
- Lipectomy is not intended as a primary bariatric procedure to correct obesity
- MBS benefits are not available for surgery performed for cosmetic purposes
- Need to have had significant weight loss (SWL)
- SWL is defined as a weight loss equivalent of at least five BMI units
- Weight must be stable for at least six months following significant weight loss prior to lipectomy
- For significant weight loss that has occurred following pregnancy, the products of conception must not be included in the calculation of baseline weight to measure weight loss against
Are you considering a tummy tuck but wondering how to manage getting around afterward?
For men and women who are considering a tummy tuck, you probably have questions. Dr. Bernard Beldholm’s blog is the place for answers! Check out our next article that is all about driving after a tummy tuck.