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diishere

which private health insurance is the best to go through for BA?

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Hi there,

 

I had my BA 3 wks ago and don't have private health insurance so had to pay everything out of pocket (except the medicare rebate for the deflated implant replacement),  however I'd like to take out private health insurance cover in case I need revision surgery down the track.

 

May one of you kind ladies please suggest which company you use, and what they covered for your BA, how much their policy costs etc.  Pretty much anything will help as I've never used private health insurance before and totally clueless on the subject.

 

Thanks heaps:) 

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To my knowledge, if the BA was for cosmetic purposes only then nothing is covered by private health funds.  If you've had it because you've had a mastectomy or something like that which comes under an item number then it will have rebates.  I'm on my parents private health fund and have the highest level of cover and am normally covered for pretty much everything but won't be getting any rebates for my BA because its purely cosmetic.   :)  I can also normally stay in a hospital without charge (like when I had my wisdom teeth out) but can't even do this for my BA.   :(  

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To my knowledge, if the BA was for cosmetic purposes only then nothing is covered by private health funds.  If you've had it because you've had a mastectomy or something like that which comes under an item number then it will have rebates.  I'm on my parents private health fund and have the highest level of cover and am normally covered for pretty much everything but won't be getting any rebates for my BA because its purely cosmetic.   :)  I can also normally stay in a hospital without charge (like when I had my wisdom teeth out) but can't even do this for my BA.   :(

oh, wow. I thought that they'd at the very least cover the theatre fees and bed :( regardless.

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Apparently it only depends on whether medicare will cover it too, I had asymmetry - one breast was an entire cup size smaller than the other, and my chest wall is all wavey because of scoliosis, but my surgeon didn't bother taking it through medicare because he said he has seen worse rejected for cover. I didn't bother trying any other plastic surgeons because I liked mine so much I didn't want the surgery done by anyone else after I met him.

I do know the surgery must be performed by a plastic surgeon (not a cosmetic), and if medicare says no, private health insurance says no.

Having said that, if medicare would have covered it my private health would have covered all else - because the hospital was affiliated with them. I'm with Westfund, and overall am happy with their cover in other areas too. Better than BUPA.

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I'm having a revision for CC at the end of the month. I'm with BUPA and they pay hospital, theatre, for the replacement implants, a small amount to the surgeon and some anaethesist. Medicare will pick up some anaethesist as well as 75% scheduled fee to the PS. He is waiving his out of pocket costs, and the hospital I'm going to waives out of pocket costs for the anaesthetic because it's s revision. I'm not sure if I have to pay an excess on my PHI, if I don't it'll cost me zero, if I do it's $500,

Medicare number 45554 for removal and replacement of the implants and removal of the capsule is $700 per breast.

I'm not sure it matters much which find you're with, as soon as you're eligible for a Medicare number your hospital expenses and replacement implants should be covered.

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I'm having a revision for CC at the end of the month. I'm with BUPA and they pay hospital, theatre, for the replacement implants, a small amount to the surgeon and some anaethesist. Medicare will pick up some anaethesist as well as 75% scheduled fee to the PS. He is waiving his out of pocket costs, and the hospital I'm going to waives out of pocket costs for the anaesthetic because it's s revision. I'm not sure if I have to pay an excess on my PHI, if I don't it'll cost me zero, if I do it's $500,

Medicare number 45554 for removal and replacement of the implants and removal of the capsule is $700 per breast.

I'm not sure it matters much which find you're with, as soon as you're eligible for a Medicare number your hospital expenses and replacement implants should be covered.

I believe, in regard to private health cover, the amount covered is down to the level of cover you have, and how much your fund actually covers - there may be out of pocket costs, and I was told it also depends on whether the hospital and surgeon have 'agreements' with your healthfund.

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I believe, in regard to private health cover, the amount covered is down to the level of cover you have, and how much your fund actually covers - there may be out of pocket costs, and I was told it also depends on whether the hospital and surgeon have 'agreements' with your healthfund.

That sounds like it could be right too, but I haven't heard about it. I suppose because BUPA are so big. Definitely worth asking a heap of questions before you sign up :)

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That sounds like it could be right too, but I haven't heard about it.

I suppose because BUPA are so big. Definitely worth asking a heap of questions before you sign up :)

We were with BUPA for a few years before switching, I found them to be a little deceptive in their wording - and often got back much less than what we initially were made to believe through their wording, like they would say 'we cover [whatever]' and when the time came for claiming we were often got caught out, because they do cover a percentage (often very low amount) but it's usually low. They have very impersonal customer service too, and some consultants were just plain rude. A couple years ago I asked about what was covered for BA and their consultant said, and I quote 'We don't just cover breast implants because you want then to look good, it's only if you have a real reason for needing them - like if you had breast cancer.' Fair enough, but no need to word it like that (Never mind that I actually did have asymmetry).

I've also found their 'members first' places, like dentists for example, are dirty and dodgy - and they cover very little of non-members first dentists.

We stayed with them too long - and I would feel terrible recommending them, given our experience (we also had top level cover with BUPA - so it felt like it was just a money sucking machine with them.

We are happy with Westfund, even though their claims process is a bit of a time consuming process (if services don't have the hicaps machine they take a while to process them, and you have to post them in even when you do the online claim) - we get more for our money, and they are very black and white with their advice - they are not deceptive, and their service is VERY personal - I usually get the same people on the phone every time.

The only issue was that BUPA took 2 months to release our information to them, and only after pursuing them from both the new insurer and ourself - so switching was also a process.

Anyway, they may be suited to some people - everyone has different medical needs etc. And I agree - shop around, see what suits your own needs. Best of luck. Xo

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Can't say I'm loving BUPA much either, I'm definitely not advocating for them! As far as ancillary cover goes, TBH we probably should even have it, we use it so little. But the rules hot the hospital part are set in legislation to my knowledge. They have no choice but to pay the 25% of the scheduled fee that Medicare doesn't cover. They have no leeway, they must cover hospital costs if you're assigned a Medicare number.

Having said that they are tightening up on some procedures, you must be pre-approved now I beleive, although when I called them maybe 6 weeks ago the agent told me that they were moving to the pre-approval model, but ended up not doing it. IDK - it just pays to ask a heap of questions :)

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Can't say I'm loving BUPA much either, I'm definitely not advocating for them! As far as ancillary cover goes, TBH we probably should even have it, we use it so little. But the rules hot the hospital part are set in legislation to my knowledge. They have no choice but to pay the 25% of the scheduled fee that Medicare doesn't cover. They have no leeway, they must cover hospital costs if you're assigned a Medicare number.

Having said that they are tightening up on some procedures, you must be pre-approved now I beleive, although when I called them maybe 6 weeks ago the agent told me that they were moving to the pre-approval model, but ended up not doing it. IDK - it just pays to ask a heap of questions :)

yep. It's a case of 'damned if you do, damned if you don't' with PHC - but it's about choosing the lesser of the evils.

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Apparently it only depends on whether medicare will cover it too, I had asymmetry - one breast was an entire cup size smaller than the other, and my chest wall is all wavey because of scoliosis, but my surgeon didn't bother taking it through medicare because he said he has seen worse rejected for cover. I didn't bother trying any other plastic surgeons because I liked mine so much I didn't want the surgery done by anyone else after I met him.

I do know the surgery must be performed by a plastic surgeon (not a cosmetic), and if medicare says no, private health insurance says no.

Having said that, if medicare would have covered it my private health would have covered all else - because the hospital was affiliated with them. I'm with Westfund, and overall am happy with their cover in other areas too. Better than BUPA.

I have asymmetry so I was given a medicare item number, as a result my Private Health fund and medicare shared some of the costs for the medical side and I covered the cosmetic side. 

That aside I do know there is some Private health insurers who will cover cosmetic procedures - you can pay extra to cover these so I am led to believe.

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I have asymmetry so I was given a medicare item number, as a result my Private Health fund and medicare shared some of the costs for the medical side and I covered the cosmetic side.

That aside I do know there is some Private health insurers who will cover cosmetic procedures - you can pay extra to cover these so I am led to believe.

I'm quite certain if I pursued it with other surgeons I might have been able to claim it, but I after meeting my surgeon I knew he was 'the one'. But then again he also added that medicare have become very strict, especially after July 1st.

Westfund also told me if there was a Medicare number it would have been covered by them too - but there may be some out of pocket costs, depending on the surgeons fees and hospital I used. Though, it is interesting you say some insurers do cover cosmetic, because the Westfund consultant also said to me there are NO insurers in Australia who cover cosmetic surgery.

I'd very much like to know which company you are saying does cover it, with the amount of money we spend on private health I'd be interested in considering them - if they do exist.

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Medicare assigns a scheduled fee to each number. They pay 75%, PHI pays 25% of the scheduled fee. But the scheduled fee is quite low, it doesn't even come close to what the surgeons fee will be. The main benefit is that they pay your hospital and theatre costs (although you may have to pay some theatre time if there's a cosmetic component).

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I'm quite certain if I pursued it with other surgeons I might have been able to claim it, but I after meeting my surgeon I knew he was 'the one'. But then again he also added that medicare have become very strict, especially after July 1st.

Westfund also told me if there was a Medicare number it would have been covered by them too - but there may be some out of pocket costs, depending on the surgeons fees and hospital I used. Though, it is interesting you say some insurers do cover cosmetic, because the Westfund consultant also said to me there are NO insurers in Australia who cover cosmetic surgery.

I'd very much like to know which company you are saying does cover it, with the amount of money we spend on private health I'd be interested in considering them - if they do exist.

I'll have to find out what company it is, my sister told me she took out private health and pays extra to have cosmetic procedures covered as she was in need of getting her tummy done after having issues from children. Whether she's saying that but misunderstanding I'm not entirely sure.

I was really unsure as to how my procedure would be covered when the PHI clearly say cosmetic procedures are not covered but in getting a medicare item it becomes medical however it wasn't a straight 50% of my procedure being covered, they paid a portion of the hospital fees and then the anaesthetist and surgeon fees were covered up to the scheduled fee which was only about $900 and something for the surgeon and most surgeons charge upward of several thousand. In any case, it helped. But I know what you mean, I knew my surgeon was the one for me so if he hadn't of stepped me through the process then Im not sure I would have gone elsewhere. he said it was simple with asymmetry though, a greater than 10% difference in size qualifies as medicare coverable, I think the lift is more tricky and that requires photos to go through and more case by case approval. 

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I'll have to find out what company it is, my sister told me she took out private health and pays extra to have cosmetic procedures covered as she was in need of getting her tummy done after having issues from children. Whether she's saying that but misunderstanding I'm not entirely sure.

I was really unsure as to how my procedure would be covered when the PHI clearly say cosmetic procedures are not covered but in getting a medicare item it becomes medical however it wasn't a straight 50% of my procedure being covered, they paid a portion of the hospital fees and then the anaesthetist and surgeon fees were covered up to the scheduled fee which was only about $900 and something for the surgeon and most surgeons charge upward of several thousand. In any case, it helped. But I know what you mean, I knew my surgeon was the one for me so if he hadn't of stepped me through the process then Im not sure I would have gone elsewhere. he said it was simple with asymmetry though, a greater than 10% difference in size qualifies as medicare coverable, I think the lift is more tricky and that requires photos to go through and more case by case approval.

Mine were roughly 20 - 30% difference in size. .BUT, Not any more! (Yay!). My PS seemed quite certain it would just not be worth trying to take it down the medicare avenue - he was adamant it would be difficult to have approved, regardless of the big difference in size between the two. I know medicare is clamping down on many areas, so I'm confident he was just being honest - and maybe they would have rejected it still - even if he did send it in (I know they do require pics now for bi-lateral breast augmentation).

Anyway, I am so happy with my result and glad I went with my PS, even if it may have cost less elsewhere :-)

It's good you were able to get yours through medicare, in any case - and with your preferred surgeon too :-) Bonus!

If you do find out that PHI from your sister please let me know :-)

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I have asymmetry so I was given a medicare item number, as a result my Private Health fund and medicare shared some of the costs for the medical side and I covered the cosmetic side. 

That aside I do know there is some Private health insurers who will cover cosmetic procedures - you can pay extra to cover these so I am led to believe.

Hi Usplusthree,

May I ask which private health insurance you used? If you don't mind :)

Thanks

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