Let’s be honest, surgery can be a costly, if sometimes imperative, investment following considerable weight loss. Consequently, one of the first things many of our clients want to know is: does my health insurance cover this procedure?
The simplest answer is that it depends on whether or not your surgery is considered necessary for your overall health. So, let’s examine this in terms of a post weight loss body contouring procedure and in this context, we’ll guide you through the, sometimes complicated, world of private health insurance and the Medicare Benefits Scheme (MBS).
First, though, let’s talk specifically about one of the main issues our clients have after significant weight loss; that is, the problem of excess skin. In essence, if you’ve lost a significant amount of weight (in excess of 20 kg or more) it is less likely that the skin will retract back to the new shape and this can cause a myriad of health related issues.
Below is a list of the most problematic areas of loose skin, the abdomen being the most common:
Inner thigh area
Post weight loss body contouring procedures are necessary for many who have lost a significant amount of weight, either through bariatric surgery or of their own accord. Losing an excessive amount of weight and the loose skin which that incurs, comes with its own, often significant, medical problems. Using your health fund to cover costs can significantly decrease the financial burden on you, provided you choose the right policy with a reputable insurer.
All of our surgical prices are easily accessible and you will find them published on our cost page. The next thing you need to do is check your level of cover with you health fund. There are a range of costs associated with surgery. However, if your health fund covers the Medicare Benefits Scheme (MBS) item number then some of this cost will be offset by your private health fund.
Health funds have many exclusions and rules and it is very important that you check with your health fund provider as to whether or not you are covered for an MBS item number. The type of private health insurance you have directly relates to how much your out of pocket costs will be, in regards to both the procedure itself and the hospital charges.
So, what is the MBS schedule?
The Medicare Benefits Scheme is Australia’s universal health care program, or Medicare, and it covers some of the cost of a procedure for some patients.
The MBS item numbers are highly restrictive. Unfortunately, for some patients, trying to make sense of the various item numbers can be very confusing and , especially with the medical jargon used, it can all seem like a foreign language. That’s why we’ve created a video to discuss the medicare item numbers that are valid in 2019. Medicare item numbers change every year, usually on the 1 November, which only adds to the confusion for patients.
As well as a video and a blog explaining the MBS and and how it relates to your insurance coverage, we’ve also created a GP referral that your GP can fill in to see if you are eligible for these item numbers.
Download your post weight loss GP referral form
All you need to do to get this PDF is to click on the link on this post and Opt-in to our email list. We’ll send you a confirmation and once you’ve confirmed your email we’ll send you the GP referral form in PDF. We’ll also send you further information about tummy tuck surgery and other post weight loss procedures. Any further queries can be answered by calling our clinic directly and talking to our friendly and experienced staff.
What are the requirements for these MBS item 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
BMI stands for the body mass index and is a way to categorise people into groups based on weight and height.
To work out your BMI, multiply your height (in centimeters) by itself and then divide your weight (in kgs) by the answer to get your BMI.
Powered by BMI Calculator
Underweight: BMI is less than 18.5
Normal weight : BMI is 18.5-24.9
Overweight: BMI is 25 to 29.9
Obese: BMI is 30 or more
Now let’s look at a BMI example of the type of significant weight loss needed to qualify for the item number, for which a reduction of at least 5 BMI units is required.
If you are 170 cm tall and weigh 130 kg (BMI 45), you need to lose at least 15kg of weight to get down to BMI of 40.
Item Numbers Available for Post Weight Loss Surgery and what they Mean
The item numbers below cover a range of what is referred to as lipectomy. Lipectomy means cutting out fat and skin. The extent of the excision will determine which item number that you receive.
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.
Our Advice to Prospective Clients
If you meet any of the criteria above, then you should make sure that your GP referral letter reflects this.
To make this easier for you we have created a specific post weight- loss body contouring GP referral form that your GP can fill in with all the relevant information about the item numbers for post weight loss procedures.
Another important thing to consider is that once you’ve figured out what your health insurer will cover, there may be a waiting period. It’s certainly possible you’ll have to wait some months before you can undergo the procedure to ensure that when you make a claim, you’re covered.