Getting surgery is a big commitment that requires a lot of thought and preparation. One thing that patients need to think about is the cost of their procedure and what it will include. Sometimes, patients might be able to get aid from Medicare. But this is only if they fit the strict criteria, which we will outline in this article.
Breast reduction mammoplasty surgery, often simply known as ‘breast reduction,’ is a common breast procedure done on women with very large breasts. It helps women get smaller breasts in order to remedy the discomfort caused by the excess weight in this area.
If you are in the process of planning and researching mammoplasty breast reduction, Medicare help may be an option. To find out if this is the case for you, read on, or contact A/Prof Mark Magnusson and his team on the Gold Coast and Toowoomba.
Reasons for breast reduction mammoplasty surgery
For women with overly large breasts, there are many incentives to have them reduced. For one, the excess weight can make it difficult to run, exercise, and participate in sports. It can also cause health concerns related to back pain, posture, and skin irritation. This means women often look into breast reduction mammoplasty for the following reasons:
- Improve posture
- Reduce back and shoulder pain
- Reduce skin irritation
- Attain a more aesthetically desired size
- Reduce pain caused by strained bra straps
Every patient is an individual with their own needs. To find out if Medicare may help with your breast reduction mammoplasty, you’ll first need to assess your own needs in collaboration with a qualified surgeon.
Types of procedures covered by Medicare
Medicare has certain criteria that a patient must meet in order to qualify for a rebate towards their surgery. Although this varies with each item number and type of surgery, there are some general things to keep in mind.
Firstly, as a general rule, Medicare only provides aid to patients undergoing surgery for medical reasons. This means that if you are getting surgery to fulfil your cosmetic goals, this is considered ‘cosmetic’ surgery and will not be covered by Medicare. Secondly, you will need to meet the criteria set out by Medicare, which usually includes a doctor’s referral and sufficient documented evidence of the medical issue.
Will Medicare pay for my breast reduction mammoplasty?
The short answer is, it depends. Even if you are eligible for a Medicare rebate, this won’t cover the entire procedure, which means regardless, you’ll have at least some out-of-pocket costs.
The longer answer is that when it comes to (mammoplasty) breast reduction, Medicare might help cover the costs if the surgery is medically required. This will not be the same for every patient, since breast reduction mammoplasty is a surgery that can be performed for either cosmetic or health reasons. If your reasons are cosmetic, you won’t be eligible. If they’re health-related, you might be eligible.
In order for surgery to be considered medically required, you must meet the criteria outlined by Medicare. There are a few MBS codes that might apply to breast reduction mammoplasty: 45523, 45520, and 45522. Only those who meet the criteria of these item numbers will qualify for a rebate from Medicare.
Common health concerns that may make a person eligible for such rebates include:
- Neck pain, shoulder pain, or back pain
- Chronic skin infections that result from large breasts
- Other health concerns that impact your quality of life
Also, choosing the right level of health insurance coverage can mean that your health fund will cover the majority of your hospital fees, such as theatre and accommodation charges, meaning less of an excess that you elect to pay as the patient.
What steps should I take?
There are certain steps you can take to find out more about the costs of your surgery. If you’re wondering whether you can get a rebate from Medicare, there are a few important things to consider:
1. Be clear about your goals
In order for a medical professional to understand your goals, you will need to assess your own motives. Why do you want this procedure? Is it because you desire a certain aesthetic appearance? Or because you want to reduce back pain or another health issue? A doctor or surgeon can help you develop your goals and understand what you can get out of surgery, but it’s important to have somewhat of an idea of this beforehand.
2. Do your research
Although your doctor can help you through the process and answer your questions, you should also do your own research. Read our breast reduction mammoplasty page to learn more about the surgery. Additionally, it’s a good idea to become familiar with the requirements of any Medicare item numbers for which you may be eligible.
3. You will need a doctor’s referral
Every breast reduction mammoplasty patient will need a doctor’s referral. This is also necessary in order to qualify for a Medicare rebate. As well as this, your need for surgery will need to be supported by documented evidence of the problem. Your doctor will need to verify that alternative methods of treatment haven’t worked and that the only solution is surgery.
4. Consult with a certified plastic surgeon
Once you have your doctor’s referral, you can then meet with a qualified plastic surgeon to speak about your options. Your plastic surgeon can help you understand the risks and benefits of the procedure in your case and whether you might qualify for a rebate. This consultation also provides us with information to determine if you are a candidate and marks the first step in the planning phase of your surgery.
Reasons to choose A/Prof Mark Magnusson for breast reduction mammoplasty in Gold Coast & Toowoomba
An important part of planning surgery is choosing the right surgeon. A qualified surgeon will help you understand the possible outcomes of surgery and your options when it comes to Medicare rebates. If you think you might qualify for a Medicare item number, speak to A/Prof Mark Magnusson about breast reduction mammoplasty. He will talk you through the process and explain what your out-of-pocket costs may be.
Contact the clinic on the Gold Coast & Toowoomba for information about mammoplasty breast reduction Medicare rebates.