Any Aussies gone down the PS route?

Fanny Adams · 08-03-2008, 12:57 AM

Our Medicare and insurance system is just so different to folk outside of Aus, that I didn't think this was worthwhile asking in the plastic surgery forum.

I'm only part way into my journey and have a long way to go, but I know I'm going to need a major boob lift and tummy tuck when I get to goal. I just spoke with my insurance agency on Friday and they've said basically if Medicare accepts the surgery as medically necessary and pays their share, then my insurance covers the balance, no questions asked. This is a darned sight easier than the runaround dramas that our US friends have to go through, but I'm still left wondering how do I go about proving "medical necessity"?

If I just go for the pannelectomy, I've heard that I need to be able to establish a history of rashes and infections under the flappy belly, so does that mean I should start going to the doc now and getting that history recorded? It might take a bit of a stretch too, as I used to get lots of them but not so much now that I've stopped trying to prevent them with Nappy Rash powders. I found those powders were the worst ever in inducing the fungus and rashes - should I start using them again to bring on the rashes, so I will get approved?

Are rashes enough to warrant the breast lift? Coz I used to get sweat rashes so badly that I have full half moon circles of scarring underneath each boob, but again, now that I've stopped the powders, these don't occur half as much. I'm not sure I could stand to bring those on again, even if it would save the money - they SUCKED!!!

What other ways have people used to get Medicare to accept a boob lift as a medical necessity? Or can't it be done? Is the pannelectomy the only one they'll go for, or have some people been able to get the full tummy tuck or lower body lift?

nat36 · 08-03-2008, 03:43 AM

Will be watching this thread with great interest as these are all the questions i have too.

She Smiles · 08-03-2008, 05:40 AM

I saw a plastic surgeon earlier this year. I didn't end up getting anything done because my health fund (NIB) and medicare would only cover $900 (from memory??) of the $20k I was quoted for a lower body lift. The whole story is in my blog (link below) in the February archives. I didn't have any rashes or a medical "need" for it, so thats why I couldn't get it covered. I'm pretty sure Chickie had most of the cost of her tummy tuck covered.

Chickie · 08-03-2008, 07:29 AM

I had a TT almost 2 years ago now, and it was pretty simple.

Went to the GP, she sent me to see a couple of reconstructive surgeons, I picked one I liked, and because I had a referral from my GP my surgery had an item number, and my fund ponied up for the op and hospital stay.

From memory (the memory is a bit wonky) I was under $1800 out of pocket (I'd have to look it up to be more exact)

Don't know about boobs. Well. I do, but you know what I mean.

Fanny Adams · 08-03-2008, 08:42 AM

Can I ask what medical grounds they gave for the TT? I think my GP would be cooperative but I'm not sure that I really have any grounds, other than cosmetic, but if there is anything that a slightly...let's say creative way of presenting the case might help, I'd like to know :)

Chickie · 08-03-2008, 08:50 AM

I don't remember the exact wording of the referral letter, but from what I do recall, there was nothing overly "creative" about it. Just stated that I had lost a massive amount of weight, and that I needed reconstructive surgery.

Fanny Adams · 08-03-2008, 08:51 AM

Wicked! There's hope for me yet! Thanks, Chickie!

slimmy120 · 08-03-2008, 10:22 AM

Fanny adams i want to do the same,so will keep you informed.plastics here i come, 6kg to get to my goal.

nat36 · 08-04-2008, 05:24 AM

Hope for me too. I find even though i still have a fair bit of weight to lose when i go for a run my stomach feels like it is going to tear because it moves so much and the same when I lay on my side Im going to tell the Dr this and see if it is considered medical

BLUEZBANDIT · 08-04-2008, 06:55 AM

I'm with you girls, a TT will be definitely a necessity. I havent been banded yet but my tummy hangs and gets i the way and is terribly uncomfortable, so when the weight goes I know it will hang even more so all your advice here is going to be closely monitored. Thanks