It appears highly likely that Medicare is intending to modify, reduce or eliminate a range of body contouring “item numbers” from 1 November 2015.
If this proceeds, it will involve a range of common plastic surgery procedures, including abdominoplasty (“tummy tuck”), thigh lift, arm lift and other body lift procedures.
If a procedure is removed from the Medicare schedule, it becomes “cosmetic”, and you will not be able to claim any rebates for the surgery, nor will any private health insurance cover hospital or other expenses.
What we expect this to mean is:
- Abdominoplasty (“tummy tuck”) surgery is likely to be removed from the Medicare Schedule, except in certain circumstances, and is likely to exclude its use for treating muscle separation and stretched skin following pregnancies.
- Various clinical indications will need to be demonstrated for use of body lift item numbers following massive weight loss.
Approximately 3,500 abdominoplasty item number procedures are performed in Australia each year. Medicare’s contribution to this service is approximately $2.5 million each year.
I am considering undergoing abdominoplasty due to pregnancy related body changes. What does this mean for me?
If the changes in legislation are approved, Medicare will not provide a subsidy for abdominoplasty, so:
- You will not receive a rebate for the doctor’s fees,
- Nor will your hospital fees be covered by your Private Health Insurance.
This means significantly higher out-of-pocket expenses for your surgery.
What if I have Private Health Insurance? Shouldn’t they cover my hospital stay?
If Medicare does not subsidise a procedure, then your Private Health Insurance will not cover your hospital stay. This means there will be significant additional costs of around $5,000 to $10,000, as abdominoplasty usually requires a hospital admission of several days.
Why are these changes being proposed?
The Department of Health and Ageing is responsible for the policy development of Medicare and the Australian Government achieving its Health Policy Objectives. Medicare benefits are paid in accordance with the legislation governing Medicare. The changes, in essence, are saying that abdominoplasty following pregnancy is a cosmetic procedure and functional benefit is not achieved following surgery.
When is the change meant to occur?
From the 1st of November 2015.
What is being done to oppose these changes?
The Australian Society of Plastic Surgeons has protested to the Department of Health and Ageing on the proposed changes. Further, research is currently being undertaken by various bodies to support the functional benefit of abdominoplasty for the Department of Health’s review. The preliminary results from a study being undertaken which Dr Merten and his patients are participating in, show a profound impact on the disability scale, from 22% to 3% for patients experiencing back pain prior to surgery.
You too can help by raising your concerns with a formal complaint to the Department of Health and Ageing, or by contacting your local federal member of parliament.
What should I do if I have been considering Abdominoplasty surgery?
For anyone who has been considering undergoing Abdominoplasty surgery, particularly post-pregnancy, we recommend that you schedule your consultation to see one of Pure Aesthetics’ specialist plastic surgeons well in advance of 1st November 2015, to ensure that there is sufficient time to schedule you in for your surgery prior to this date.
If you have any further questions, please feel free to contact our practice on 02 9199 7448 or email email@example.com.