private insurance
unknown
Member Posts: 45 ✭
Hi, not sure but did someone comment that their private health provider wasn't going to let them claim on fat transfer / grafting costs but then after discussion said they could claim on their private health insurance? not sure where I read this, maybe it was on the 'reclaim your curves' website. I will check them out as well. cheers, Marion
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That may have been me. I had a DIEP recon in 2014 and needed lipofilling (fat taken from my hips) to fill out a large dent in the newly reconstructed breast when a seroma was drained after the surgery. It was initially questioned by my health fund (Medibank) as they were trying to say it was cosmetic surgery. Thankfully my plastic surgeon was able to put forward the case that it was part of the reconstructive process and was revision surgery. I also had to argue for cover for my nipple reconstruction- again they were arguing it was cosmetic surgery but finally agreed. It was a frustrating experience as if I'd been going through the public health system there wouldn't have been any question about any if these surgeries as they are covered under Medicare.
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I have to concur with Jane! that was pretty much my scenario, but my Plastic Surgeon put me through the public system which was awesome. So everything has been covered, there are alot of PS that work the public system as well, the only reason as I said it worked for me was I had a recurrence so I was Category 1 not much waiting so had the Mastectomy/Diep Flap, though it was only a 2 inch disc of tummy skin not a complete flap but filled with my tummy
they talked me out of private purely for the out of pocket, Id used private for 6yrs and I still do, however am glad I didnt for this. 0 -
thanks for responses.. Jane I am with Medibank as well. l will go in and talk to them, see what they say. And if not successful will ask my surgeon if he can state that its part of the reconstructive surgery. Interestingly Medibank pay for surgery to treat scarring from cancer surgery?? I hope you all have a great day.0
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Best of luck with your discussions with Medibank, hopefully they may be more informed about the difference between reconstruction and cosmetic surgery these days. You could always take in the information from BCNA's breast reconstruction page that clearly states that breast reconstruction is considered a medical procedure, not cosmetic surgery: breast-reconstruction .
You might also find this page about public vs private breast reconstruction from Cancer Australia (the Aust Govt website) useful: click here0 -
Trying to put that second link in again: private vs public0
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thanks Jane. great idea about taking fact sheet info with me. Marion0
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Hi Marion @unknown
How did you go with your fat transfer (autologous fat grafting) procedure...?
Was this for whole breast reconstruction, and your first operation (not revision surgery such as @Jane221 )
I'd be interested to know if your private health insurer Medibank paid for any of the procedure, as opposed to only paying for a very small portion of it relating to scar revision.
I've been told there are no Medicare Item numbers assigned for autologous fat grafting, and when Medicare don't recognise the procedure, neither do the private insurers. They have a propensity to rush towards a conclusion of cosmetic, even when you have nothing there.
It's considered too new a procedure in Australia and still approx 6-9mths away before a Medicare working committee will action a new Item number. Too late for me, unfortunately.
Would love to hear your experience, cheers Lana
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Hi @Lana10, sorry but unfortunately I can't find the paperwork from my surgeon for that procedure, which was a revision rather than a full autologous fat graft, but would suggest talking to your surgeon's office as they are usually aware of all the item numbers attached to particular procedures. Best of luck, Jane0
