Health insurance for excess skin removal

Can health insurance cover excess skin removal?

Private health insurance can cover you for excess skin removal, but only if it is medically necessary. It's covered through hospital cover under "Plastic and reconstructive surgery (medically necessary)". That treatment category is included in all Silver policies and above, but also on a few Bronze Plus policies as well.

What counts as medically necessary?

Clearing the 'medically necessary' bar will be different gor everyone. Start by talking to your GP and your insurance providers. That said, a few of the conditions you might need to meet include:

• Your BMI has dropped at least 5 points.
• Your weight has been stable for 6 months prior to the surgery.
• You've developed a secondary skin condition that threatens the health of your skin and has failed other forms of treatment.
• The excess skin interferes with daily living.

Waiting periods for excess skin removal

All hospital policies have waiting periods before you can make a claim. For excess skin removal, the standard waiting period is 2 months. However, a pre-existing condition will bump that waiting period up to 12 months. This is pretty common for excess skin removal, due to the nature of the condition.

Medicare vs insurance for excess skin removal

Medicare

Medicare will pay for 75% of the MBS costs if you receive treatment as a private patient in a private hospital. There are a few different Medicare item numbers associated with excess skin removal – all depend on the type of procedure you will receive. For example, 30177 is for a lipectomy.

Private health

Private health insurance will pay for the remaining 25% of the MBS fee. However, your surgeon will probably charge a lot more than the MBS fee, and you'll likely have an out of pocket fee. You insurer could have a no gap fee agreement with a hospital, but it's pretty uncommon for excess skin removal.

Pros and cons of going private

Out-of-pocket costs for excess skin removal

When you use private health insurance, you will often still have an out-of-pocket costs to pay.

The federal government's database, Medical Costs Finder says 94% of private abdominoplasty patients had an out of pocket fee, with the average cost being $7,500. It says the upper range of that gap can be as much as $12,000.

Knowing your out-of-pocket cost ahead of time can be hard - it's a known issue with private healthin Australia. The best approach is to call your private health insurer as soon as you get a GP referral. Then, before your surgery, have it confirm in writing what you'll be covered for.

Frequently asked questions

• Is excess skin removal covered by private health insurance?

  Yes, it can be. However, it needs to be medically necessary and not for cosmetic reasons. For example, you typically need to have lost a substantial amount of weight (at least 5 BMI points), have developed skin conditions and are unable to do everyday activities such as exercise.

• Does insurance cover getting rid of loose skin?

  Health insurance companies in Australia must cover weight loss surgery as part of their Gold level policies which can include excess skin removal. However, it needs to be medically necessary. You won't be covered for cosmetic surgery.

• Does private health insurance cover abdominoplasty?

  Abdominoplasty – also known as a tummy tuck – is not covered by private health insurance. This is because it's generally done for cosmetic purposes. Private health insurance will only cover you for medically necessary treatment.

• How does skin removal surgery work?

  To remove excess skin, your surgeon will make incisions into the area where the excess skin is located, lift the skin from the underlying tissue, trim it off, reposition the navel if necessary and stitch up the wound.

  If liposuction is required, the process is the same except they'll remove the excess fat before trimming away the skin. They do this by hollowing out little spaces within the fatty tissue. After they trim the skin and stitch the wound, they'll give you a compression garment that will collapse these hollowed-out spaces to create a contoured body shape.

  In the case of a tummy tuck, the process is again the same, but your surgeon will stitch together any loose or separated abdominal muscles prior to removing the fat.

To make sure you get accurate and helpful information, this guide has been edited by Tim Bennett as part of our fact-checking process.

Written by

Gary Ross Hunter

Editor, Insurance

Gary Ross Hunter was an editor at Finder, specialising in insurance. He’s been writing about life, travel, home, car, pet and health insurance for over 6 years and regularly appears as an insurance expert in publications including The Sydney Morning Herald, The Guardian and news.com.au. Gary holds a Kaplan Tier 2 General Advice General Insurance certification which meets the requirements of ASIC Regulatory Guide 146 (RG146). See full bio

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