Breast reconstruction and breast implants

Hi, I have tubular breasts. I have found that Medicare and private health both cover breast surgeries to correct this. I can't get my head around how it works. If I am going private but with Medicare cover aswell how much will I be out of pocket. I can't find what Medicare deem as the correct cost and what they exactly cover. I need to know how much out of pocket I'll be or how will I be expected to come up with the money. It's so confusing. For example if surgeon costs are $6500 how much does Medicare and private cover? What other costs are there involved and what would a rough out of pocket figure look like?

Amy.88 August 18th, 2016 NSW

  • Answer
     Gavin Sandercoe

    Gavin Sandercoe

    33 answers

    Plastic Surgeon
    New South Wales, Australia

    Hi Amy
    Yes, the system is confusing. Medicare has an item number (code) for breast augmentation +/- lift for tubular breasts. If you have a high enough level of health insurance, then your health fund also helps cover the costs (but you may have an excess to pay to the insurance company). What that means is that the costs of your implants, operating theatre time, hospital stay should all be covered. Between Medicare and your health fund, they will partially cover the costs of your surgeon, anaesthetist and assistant. There is very likely to be a gap you will need to pay your surgeon & anaesthetist. The amount of the gap will vary between surgeons, and health funds. You are best to call the rooms of a few surgeons to get a feel for costs.
    Good Luck
    Dr Gavin Sandercoe