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taniya7130

Medicare/Health Care Rebate & Surgery costs.

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Hi ladies, I was sure there was a thread on here somewhere about about this topic but from my search it seems to be in dribs & drabs or mentioned in others threats. So I'm sorry to those who have mentioned this topic before & I hope you don't mind repeating your self's. I'm going to be very specific with this.

OK, as some of you know I had my surgery 5 weeks ago. I had a TT (with muscle repair), a BL/BA & arm lipo all in a 9hr op. I had 5 days in hospital. My surgeon is a cosmetic surgeon & not a plastic surgeon. I am EXTREMELY happy with his work!

I personally had to pay everything upfront.

$ 150 for my initial consult (back last November)

$17,300 to my surgeon

$ 5,230 to my anaesthetist

$ 450 to the hospital for private health care excess (Private Health will the rest of my hospital/theater)

$ 365 for the compression garments I took to hospital/theater (Compression bra, body suit for TT, compression for arms & compression binder, that I'm not allowed to wear yet)

$ 235 for the 2nd set I got when I got out of hospital (I needed to wear something while I washed & dried the other lot. I just got another bra & body suit with legs)

updated 14/12/13 for compression garments $100 back from HCF

Since surgery I have also had to pay out;

$ 28.30 for take home medication

$ 404.20 for pathology (my surgeon had a mole on my tummy tested) Updated 14/12/13 $117.05 Medicare & $38.95 HCF

So to date my surgery has cost me (or should I say, my hubby) $23,752.50

I have put in to Medicare &/or my health insurance everything I have a receipt for (which is all of the above). To date I have received;

(from memory) about $65/75 of the $150 for initial consult & I got that back as soon as I put my receipt into Medicare last November, immediately after initial consult.

$ 675.10 from Medicare of the $3703 for anaesthetist costs I could claim for. (the other $1500 I couldn't claim as, I believe that component was for the arm lipo which was cosmetic). Updated 14/12/13 $212.85 back from HCF

I have to admit, so far I am a little disappointed as to what I have gotten back, but not really surprised, as I have read some of what others have said about this. I will keep this post updated by editing it when I receive more. My hubby is even more disappointed as he was looking to use the rebate to build the retaining wall we much need out the front of our house. Time will tell.

Hopefully this will give others exactly what you are looking at getting as far as rebates go. I do believe however there could be differences in what you receive from your health fund depending on your level of cover.

I would also like to add that when my hubby did his tax the other week he asked about claiming this surgery on his tax next year & they said he could so a ++.

And I have to keep telling myself & hubby, I am so happy with my new body (even though I still can't use it properly yet) that anything we get back is better than nothing at all.

PS: As I'm on the topic of costs, & 1 which I'm not sure if it's worth mentioning, but I also just payed out about $165 for some dressings, extra chlorhexidine surgical scrub & some waterproof dressings my surgeon has told me to take to Thailand with me, for the open part of the TT scar that I have developed. I believe that I got a really good price for these through a wholesaler. I doubt I be able to claim these, in fact I wont even try.

I hope this is of help to others & those that have had their rebates please feel free to add to this as I am still interested in what I may receive yet. Again, sorry to those who may be repeating them selves.

14/12/13 update refund so far from HCF $351.80

refund so far from Medicare $862.15

As of today 14/12/13 I still have not received ANYTHING back for my surgeons costs. Its been 12 weeks since my surgery.

UPDATED 29/03/14 I have now received $1416.20 from Medicare for my surgery costs from item no. 45558

I have also received $472.05 back from private health for item no's. 45558, 30177 x2

UPDATE payed on 15/05/2014

HCF $2004.02 for theatre costs. (I kept getting a nasty bill from the hospital asking ME!!! to pay this amount. I nearly cried when I got the 1st bill as I thought we'd payed out everything)

I think this is all my refunds I'll get back from this surgery.

Total out of pocket cost of surgery for me $23,752.50 (+ the $2004.20 for the theater fees which I personally didn't pay out for. I thought paying the excess was it...& as it turn't out, the excess was all I personally had to pay)

Total refund from HCF $1175.65 (physically refunded to me + $2004.02 went directly to the hospital)

Total refund from Medicare $3140.50 (all physically refunded to me)

Total refund I received $4316.15

Therefore my total cost of surgery $19436.35 & honestly the best 20K I have EVER spent!!! :D

I hope this helps others with a realistic view of what you actually get back. It isn't a lot but it's better than nothing.

I wish you all well on your own surgery journey's.

:-x Tarn's

Edited by taniya7130

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You have to remember that Medicare doesn't usually pay out for cosmetic procedures, unless it's something considered medically necessary.

Also, your private health insurance doesn't usually pay for cosmetic surgery that medicare hasn't approved. In general, medicare pays a portion of the cost, insurance pays the balance...UP TO the medicare schedule fee. What's left is your out of pocket costs. Just because your surgeon charges, say $10,000, doesn't mean you get that much back. If medicare says the procedure should cost $1000, then that's what the rebate is. The other $9000 is yours to pay.

After my research, I found you'd be paying about 1/3 - 1/2 of the surgery costs, provided you have insurance to pay the hospital fees.

You can claim a % of the out of pocket expenses on your next tax return. You can also claim the cost of dressings and such (so Taniya, keep those receipts for dressings).

Really, you just have to put the money aside for something you really, REALLY! need to do and forget about it. It's not like it's money down the drain, is it?

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Hi,

I am booked in for TT and BA/BL in August next year and I also have a question regarding this topic.

My surgeon quoted me costs for both insured and uninsured. The insured costs come to $12,500 out of pocket compared to 22,000 if I were uninsured. Does this mean, come surgery time I still have to pay the full amount ($22,000) and then I get reimbursed the rest or do I only ever have to come up with just $12,500?

Sorry if this sounds like a dumb question but I have a hard time getting my head around all this rebate and insurance stuff lol.

thanks in advance , hope someone can help :)

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Like wise Kb2904 it is VERY confusing & when you call Medicare they don't give you much info on it either. That's why I started this post. Personally I had to come up with the whole amount then waiting to get rebated. Like I said in my 1st post I will keep you informed.

flowery, part of my surgery was cosmetic (the arm lipo) & I knew I wasn't getting anything back for that. The TT & BL/BA had Medicare number that went along with that part of the surgery so I am expecting a rebate on that part of the surgery. My anaesthetist has taken out the $1500 part that was considered cosmetic of his fee & I have been reimbursed from Medicare their part of the rest of the anesthetic fee. I am waiting to see what my health fund pays as their share of the anesthetic fee. Then there's the rest of my surgeon's fees to come. That was the largest cost part of my surgery & the sundry part, eg; compression garments etc.

I didn't think I would bother with the extra dressing part but since you said, maybe I will. Thank you. Do you know if it's private health or Medicare that pay out on those?

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Kb, usually the surgeon will want his/her entire fee up front, then you put the bill in for a rebate. The hospital will bill your health insurance direct for their fees and you only pay your co=payment or excess. If you don't have private cover, you'd probably have to pay the hospital fees upfront. Then the anaesthetist will send you a bill after the surgery. There are lots of bills!

Did your surgeon say if the $22000 was just his fee, or including the hospital fees? If it's just for the surgery, you need an estimate from the hospital as well. He should have given you an itemised account.

Just as an example, my costs were $6500 surgeon fees( I paid about $4500) ; $1500 anaethetist ( I paid $1000) ; $6500 hospital (I paid $50)

Taniya, with the extra dressings, compression garments, creams, pills, even bio-oil, you can claim out-of-pocket expenses on next years tax return. That is, anything relating to the surgery that you have not received payment for via medicare or insurance, keep the receipts and hand them over to your accountant. It's about 20% of expenses over $2000? or so, so it's useful to claim.

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Each surgeon approaches this differently.

I paid the gap to my surgeon prior to surgery and the excess on my hospital costs. The anaethesist I paid in full upfront. After surgery I was sent a seperate invoice from my surgeon for the scheduled fee payable by Medicare (3/4) and BUPA (1/4). I took the scheduled fee invoice and the anaethesist a invoice to Medicare after my op and they paid the scheduled fee for the anaethesist into my account, and later I was sent a cheque from Medicare and I think from BUPA made out to my surgeon which I forwarded to him.

Taniya - you should get back some $$ from the surgeons fees too. All my first surgery was covered by Medicare numbers - no cosmetic component, and I was still out of pocket for my anaethesist. The scheduled fee just falls short of the true cost. Also, I was under the impression that the tax rebate for medical expenses was scrapped? I claimed last year, and as part of the transition because I did I can claim again this year (but won't have enough expenses to). But my understanding is that it was scrapped as part of the last federal budget.

Flowery - a Tummy Tuck and Breast Lift both have Medicare numbers (if the relevant criteria are met) and are recognised by Medicare as being reconstructive surgeries not cosmetic. Many of the girls on here have serious pain, hernias etc from daistasis rectus. The muscle repair component of a Tummy Tuck is what makes the recovery so huge.

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Just a comment of claiming on your tax return. Refer to

http://www.ato.gov.au/Individuals/Tax-return/2013/Supplementary-tax-return/Tax-offset-questions-T4-T11/T6---Total-net-medical-expenses/

And http://www.ato.gov.au/General/New-legislation/In-detail/Direct-taxes/Income-tax-for-individuals/Net-medical-expenses-tax-offset-phase-out/

unless the surgery has a Medicare item number you pretty much cannot claim that portion.

You need to use itemised statements from Medicare and private health insurer to calculate what you can claim and statements from chemist showing prescriptions filed. Over the counter items such as panadol, wound dressings, betadine etc cannot be claimed unless prescribed.

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I should also add... From 1 July 2013 taxpayers who claimed the Offset for the 2012‑13 income year will continue to be eligible for the Offset for the 2013‑14 income year. So if you haven't claimed on the returns being lodge right now your out of luck and can't claim in the 2014 return

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As Jaddles mentioned I had to pay my anesthetist fees up front as well. The ONLY part of my surgery I DIDN'T pay up front was the hospital fee. But as mentioned in my 1st post I did have to pay the excess up front at the time of admitting to hospital.

I did receive a letter from Medicare today stating "I refer to a claim to the Medicare Claims Review Panel (MCRP) for consideration of Medicare Benefits Schedule (MBS) item ***** - Unilateral correction of breast ptosis - provided by Dr.

Claims for this MBS item must be accompanied by sufficient clinical and photographic evidence to enable the MCRP to assess whether a Medicare benefit is payable. Photographs must be signed by your practitioner to certify that the photographs have not been altered. Please submit clinical details and certified photographs to support this claim to the following address

So I am presuming that my surgeon has not submitted the photo's taken before surgery to Medicare. I'm not sure is that's even the protocol, or if I was supposed to get the photo's from my surgeon & submit them with my claim forms. Jaddles do you know the answer to this one? I have emailed my surgeon tonight with the letter in full.

Wannabbs, my surgery was done on the 20th Sept this year. Even though my hubby did his tax after this date we did not try to claim anything this year as my surgery was not done in the last financial year. (Sill confused here lol Not really that hard... & I cant even put it down to being blonde lol Sorry all you bright blondes out there ;-}) So your saying that we WONT be able to claim this surgery next year? Hubby's accountant was still under the impression that we could...

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A BL must be approved by Medicare, your surgeon has to send pics away. It sounds like your PS hadn't yet, or Medicare haven't approved it yet. Someone once said on here that the review panel only meet every 3 months. I just took my invoices into my local Medicare office - either they could see on the screen that it was already approved on their end or when it was sent away they cross referenced my claim with their approval.

The changes in the last federal budget mean that unless you had a claim for medical expenses in 2013 tax return, you are unable to claim a rebate on your costs in the 2014 tax year. Did you make a claim in the tax return you just did/will do soon? If not, would your dentist, physio, Chiro, prescriptions be in excess of $2,160 between 1 July 2012-30 June 2013?

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Yea so pretty much if you don't claim in the return 1 July 2012 to 30 June 2013 for medical expenses, you can't claim in next return which is the one your surgery would fall into.

They are winding it down and totally getting rid of the offset apparently, only will be for aged and disabled until the new disability care fully comes into effect.

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Wantbbs, you had me worried about the tax + medical expenses. I've reduced my taxable income considerably over the past couple of years by claiming medical!

This is what the ATO website says about the 2014 tax year medical expenses offset;

[h=2]"Net medical expenses tax offset[/h] The amount of net medical expenses tax offset your clients can claim now depends on their level of income.

Your clients can only claim an offset of 10% of their net medical expenses over $5,000 if they have an adjusted taxable income (ATI) above:

  • $84,000 if they are single
  • $168,000 if they are a couple or family.

The family threshold will increase by $1,500 for each dependent child after the first.

If their ATI is below these income thresholds, they are not affected by this change and can continue to claim an offset of 20% of their net medical expenses over $2,120."

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NaeNa, If I'm reading it right, you won't be affected by the changes to tax rebates. BUT! I'd suggest calling the ATO and checking with them. And you don't get the money back, just a rebate on a portion of it. In my case, it meant my tax payable went from 'pay us the money" to "we'll pay you money" aka a refund. I was happy with that!

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This is so NOT what I needed just before Christmas.

OK I received a letter from my private health fund last week saying that they had payed a portion of my hospital cover for my ops. Then yesterday I received a letter from the hospital stating that I now owe them $2004.02

WTF???? I was under the impression that I'd payed the $450 excess & that my health fund would cover the rest.

OK the lay out of this letter from my Hospital.

FROM(ON) TO ITEM CODE COST TOTAL COST

20/9/13 21/9/13 1 day ASU/SHARED ROOM 900.00 900.00

21/9/13 24/9/13 3 day ASU/SHARED ROOM 900.00 2700.00

20/9/13 1 LIPECTOMY RAD ABDOMIN 30177 2306.00 2306.00

20/9/13 1 BREAST PTOSIS CORRECTION 45558 .00 .00

20/9/13 1 VENTRAL INCISIONAL OR REC 30403 .00 .00

20/9/13 2 CEREFORM SLILCONE GEL FIL MW012 610.00 1220.00

20/9/13 ADMINISTRATION SET SI040 7.00 7.00

Invoice Total 7133.00

20/9/13 DEPOSIT - Eft 156654 EFTPOS -450.00 my excess

9/12/13 FROM Hospital Contri 158914* DIRECT -4678.98

BALANCE PAYABLE IN 14 DAYS 2004.02

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

My invoice from my surgeon (sorry if I'm repeating myself here. I'm just so shocked!!!!)

29 Aug 13 (they got the date wrong on my paid invoice. Should have read 20/9/13)

Lipectomy - radical abdominoplasty (inpatient) 7000.00

20 Sep 13 Vaser UAL Arms 2000.00

45557* Bilateral mastopexy with Implants 8100.00

SUBTOTAL 17100.00

GST 200.00

TOTAL AMOUNT 17300.00

I PAYED THIS FULL AMOUNT 2 WEEKS BEFORE OP

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Sorry for this epic post, I will be queering this with my surgeon when I see him on the 18th Dec for my 3 month check up.

The way I see this (& PLEASE CORRECT ME IF I'M WRONG) is that I have payed for my implants to my surgeon as is seems to be included in his bill & I will also be paying for them to the hospital as it is also included in their bill.

I was also under the impression that after paying my hospital excess that my hospital bill would be covered in full. I was NOT informed otherwise. In fact the opposite. I was told by my health fund that with the item numbers I had given them they would cover my hospital in full, I just had to pay the $450 excess.

I haven't got the guts to tell my hubby about this bill yet, until I find out some more info.

I still haven't received anything back from Medicare or Private Health for this op apart from for the anesthetist $675.10 Medicare & $212.85 HCF from $5203.50.

I have also received $100.00 back of $587 from HCF for my compression garments.

Has anyone else had any of these unexpected bills after their op? & how long does it usually take for Medicare to pay out?

Did you have to put the info + photo's into Medicare yourself or does your surgeon do it?

So many unanswered questions lol & it's so hard to get answers.

That's my update for now, I'll keep bumping this up when I know more.

Edited by taniya7130

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Thanks to those who had comment about the whole tax thing but I'll just wait for 2014 tax time to deal with that one. ATM I', more interested in getting a rebate & somehow getting away with paying this extra 2k in hospital bills. Did anyone else receive a nasty unexpected bill like this when they thought they'd payed out for everything?

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Oh no Taniya! I hope you find out from Goldman whats going on, I am interested to know what he says because I will be in the same situation I imagine, I haven't even had time to go to medicare or private yet but when I do I will let you know what happens, good luck

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I had a BA and my GP said i dont get anything back from medicare because it is a cosmetic procedure. damn!

if anyone has ideas on loopholes.. (self esteem probs etc? ) lol please share! :)

Unfortunatly for you YaySoClose, I think it's too late to do anything now that your op is done & dusted or you could possibly have gone for something (not that I can think of anything lol). It would be interesting to know if others had had a BA done for "self esteem problems" & got Medicare to cover it. I'm sure you would have to have some kind of long standing proof, of possibly mental illness because of your flat chest.

I did get a referral letter from my GP to begin the whole process & my surgeon put a medicare item number on the procedure. My situation of Medicare not paying out as yet is mainly because a) my surgeon has been too busy to put the relevant info into Medicare or B) been to slack to. + fortunately for me mine wasn't just a standard BA but a BL with implants & also went along with a TT.

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I think most most of the insurance companies pay only for accidental medical expense rather than to pay for these surgeries. Because they cover the risk that you have to face in any accident either general or vehicle. So it depends on the term and condition that you have in your agreement with that insurance company.

Edited by Mack

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So I went to see my surgeon on the 20th (as well as emailing my concerns b4 I went). He said that it is all because Medicare haven't done their bit yet. He reassured me that he has now put in the relevant info into Medicare & if the hospital contact re this bill, for them to get into contact with him. Still in the waiting process... Hoping for a "Happy New Year!" lol

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It is true that no matter what kind of surgery you are getting done it will always cost you much. When you select any renowned surgeon then you need to be aware that you are reserving a lot of time of that expert surgeon in order to receive better treatment and in exchange you have to pay good amount of money that will substantially provide you surgery discussion, treatment cost, follow ups and other consultations. In all kinds of cosmetic surgery you will find skin resurfacing including chemical peels cheaper but it can be still expensive. I have my personal Plastic Surgeon in Florida called Cheryl Odell who is Famous for Plastic Surgery and Cosmetic Surgery in US. Bus she didn't require much cost for Surgery and I think difference can be happen and it totally depend on mentality and humanity.

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I rung Medicare on Monday to see how my claim was progressing. The lady I spoke to said that she would put me on hold & contact the Assessing & Benefits department (1st time they have done this when I have rung). She got back to me saying that she can see my claim but are waiting on my surgeons clinical notes & photos. WTF!!! he said b4 Christmas this was done. So I rung his office & was told that he had been very busy & with Christmas & all he hadn't done it yet. NOT HAPPY JAN! :mad:

So I am at my surgeon's whim at the moment, waiting for him to do what he has to do. I was told that this board meets once a month in Canberra to view, assess & pass down the benefit's.

I'm just playing the waiting game now. Hopefully I can post some more info by March for all those that are interested on how this process works.

I have been told by other forum members that their claim was processed quite quickly, so good luck with yours...

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