Will My Insurance Pay for Rhinoplasty?

Will my health insurance or Medicare contribute to the payment of my rhinoplasty?

In many cases the answer is yes.

Private health insurance companies are required to pay for medical services that fall under the guidelines of the Medicare Benefits Schedule (the MBS) if a patient is covered for those services as part of their policy. A comprehensive or “top cover” policy generally covers all services in the MBS.

To save on cost, some patients take out private health insurance policies that exclude certain categories such as plastic surgery or obstetrics for example. If this is the case you may not be covered for a rhinoplasty which falls under the plastic surgery category. Usually policies can be upgraded but the funds often require a twelve month waiting period before these services can be undertaken.

In every case, health funds and Medicare will only help pay for surgery if it falls within strict guidelines. These guidelines are listed as “item numbers”. Most rhinoplasty item numbers are worded this way –

“Rhinoplasty…for correction of nasal obstruction or post-traumatic deformity (other than deformity resulting from previous elective cosmetic surgery), or both. “

This link will take you to the Medicare Benefits Schedule site and open the rhinoplasty services with their conditions:

http://www9.health.gov.au/mbs/search.cfm?q=rhinoplasty&Submit=&sopt=S

This means that in order to be claimable, the purpose of the rhinoplasty must be to correct either nasal obstruction (a blocked nose) or a deformity that was cause by trauma.

A rhinoplasty performed for other reasons (for example a cosmetic rhinoplasty where no trauma has occurred) cannot be claimed under Medicare and private health insurance companies. It can of course still be performed but there will be additional costs involved.

Dr Roth and his team can assist with determining your eligibility for a rhinoplasty that may be covered by your health fund and Medicare. It is worth looking over exactly what is included in your health care cover. If you need to wait twelve months before accessing plastic surgery services on your policy it may be wise to get things started sooner rather than later.