On the first of November this year the Medicare Benefits Schedule will contain significant changes to item numbers where there may have been previous ambiguity about whether they could be used for cosmetic procedures. The Government has been concerned for some time that there is a potential to misinterpret item numbers to claim for surgery that may be construed as being cosmetic in nature. Specifically, it has been concerned about revision breast implant surgery and rhinoplasty. The Government is also concerned about the revision of overseas cosmetic surgery being performed within Australia at taxpayers’ expense.
The Australian Society of Plastic Surgery has been working closely with government to ensure that any changes align with community expectation of what is fair and reasonable, and that patients in real need are still able to be treated. We have been able to effectively advocate that patients who have congenital deformity, or deformity as a result of trauma or cancer, will continue to be eligible for treatment within the MBS.
In essence, the new changes mean that any patient who seeks to have cosmetic surgery, or repair, or revision of previous cosmetic surgery, whether performed either within or outside Australia, will be unlikely to be eligible to claim through the MBS, and therefore their Private Health Insurer.
The enforcement of these changes will be comprehensive and monitored. It is clear from our discussions with Government that they expect a variety of numbers that have up to now been used widely, to be now used only in the rarest of situations. Successful claimants will need to be able to provide clear, unequivocal, photographic evidence that the surgery performed was not for cosmetic purposes, or to correct deformity that occurred as a result of previous cosmetic surgery.
The impact of these changes means that any re-do cosmetic surgery will now need to be paid, in full, by either the patient, or the surgeon who performed the original operation. Patients need to be absolutely clear who is responsible for paying the costs of any revision surgery, should it be required. My advice would be to get this clarified, in writing, before any cosmetic surgery is considered.
The good news is that congenital deformity, cancer-related deformity and traumatic deformity will continue to be covered. It is also pleasing that we now have an item number to reflect that breast reduction surgery is most normally a bilateral procedure. This also means the “banding” in private hospitals may now change and we expect patient out of pocket expenses to decrease.
These changes to the MBS will take place from November 1st 2018 and hence I would strongly suggest any patient who may be potentially affected by this change, particularly if they are considering revision of previous cosmetic surgery, to contact their surgeon promptly for advice and review of their result.
Now, more than ever, the adage, ‘do it once, and do it properly the first time’, has never been more pertinent. An initially cheap surgery offer may seem attractive, but it will now cost patients a lot, lot more if it goes wrong, and you seek to have it revised.
Professor Mark Ashton MBBS, MD, FRACS
Professor of Surgery, University of Melbourne
President, The Australian Society of Plastic Surgery
Cosmetic Journey would like to thank Professor Mark Ashton, specialist Cosmetic Plastic Surgeon for his input into this blog post.
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