Breast reduction Medicare cover can be granted if you will be undergoing the procedure for certain medical reasons.
By removing tissue from the breasts, typically an appropriate amount of skin and fat, the procedure reduces the size and weight of the breasts. The size and weight of the breasts can be a source of some discomfort, and other issues that can prompt a patient to undergo the procedure.
In this blog, we’ll explain how the breast reduction Medicare process works, and discuss your eligibility for Medicare cover.
If you would like advice based on your personal circumstances, please feel free to contact our Perth-based team and ask any further questions. Specialist Plastic Surgeon Dr Anh can also assess your needs during an in-person consultation.
Step 1: Establishing your reason for having a breast reduction
Patients have the option to elect a breast reduction for reasons that are mainly aesthetic-based or have the procedure to reduce medical concerns.
Essentially, if you want to undergo the procedure to reduce the size of the breasts for the purpose of altering their appearance, this wouldn’t be considered a medical reason.
However, if your reason for having a breast reduction is to address physical discomfort or physical issues, you may be eligible. Even though your procedure will be motivated by medical concerns, Dr Anh will still consider the aesthetics of your results when planning the steps of your procedure.
Having a medical reason to undergo a breast reduction is actually quite common. Often, those who have particularly large and heavy breasts may experience back, neck or shoulder pain, frequent headaches due to this pain, and issues with posture. It can also be harder to keep the skin beneath larger and heavier breasts clean and dry, which can lead to skin irritation or even reoccurring infections.
The size of the breasts can also interfere with mobility, making it more difficult to exercise, comfortably wear bras or other clothing, and complete certain daily tasks. At this point, the concerns caused by the size and weight of your breasts could be interfering with your daily quality of life.
These reasons can make you eligible for breast reduction Medicare cover, as long as you and your GP or specialist can clearly prove the need for the procedure.
Step 2: Seeing your GP or specialist for a breast reduction referral
To help you ensure that your reason for having a breast reduction would be medically necessary, as well as meet Medicare’s eligibility requirements, the next step will be to see your GP or specialist.
Your GP or specialist will be able to properly assess your breasts, examining the size and shape and the impact it could be having on your neck, shoulders or back. They can also assess the condition of the skin beneath the breasts, as well as your posture and how the weight of your breasts could be affecting this.
If your GP or specialist believes a breast reduction would be medically necessary, they can then write you a referral to see Specialist Plastic Surgeon Dr Anh.
As part of the assessment process, they will typically need to find the right Medicare Benefits Schedule (MBS) Item Number. The item numbers relevant to a breast reduction can outline the suitability requirements, as well as the specific costs that Medicare can cover, which we will discuss in step three.
If you’re curious about the breast reduction Medicare Benefits Schedule Item Numbers, you can look them up and read their details on MBS Online. You can find these item numbers under item 45523 (bilateral breast reduction), or 45520 (unilateral breast reduction). The item numbers are public information, so you will be able to refer to their details whenever you need them.
Step 3: Understanding the exact costs that Medicare can cover
Now that we’ve outlined the overall Medicare process for breast reduction, it’s important to stress that Medicare can only cover a portion of your breast reduction costs.
However, depending on your circumstances, this can still be a great portion of your costs and a great help in the affordability of the surgery. Your relevant item number may specify the percentage of the procedure costs that can be covered. Currently, the amount specified for breast reduction Medicare item numbers 45523 and 45520 is 75% of the procedure’s costs. This will mean that you will be responsible for covering the rest of the procedure fees.
If you have private health cover, however, they may be able to assist you in covering these additional fees. This will entirely be up to the requirements set by your provider, and the details of your level of cover. Ideally, you should contact your provider for more information before having a breast reduction.
The percentage of the fees that can be covered by Medicare typically includes part of your surgeon’s fees, anaesthetist’s fees, and public hospital fees. If you would prefer to undergo the procedure in a private hospital, you can have some of your surgeon’s and anaesthetist’s fees covered, and cover the hospital fees with your private health cover.
It’s important to remember that, no matter what is listed online, it is always going to be most important to listen to the personalised advice provided by your GP, specialist, Medicare, private health insurance provider or plastic surgeon directly.
Step 4: Having a consultation with your surgeon
Before putting through the Medicare cover application, your Specialist Plastic Surgeon, Dr Anh, will need to conduct further assessments to ensure your suitability for the procedure.
While assessing your suitability, Dr Anh can discuss your reasons for undergoing the procedure and determine if the approach will be right for you. Then, the assessment of your personal needs will help her to plan a detailed procedure, should you be considered suitable.
The specific details of your breast reduction procedure plan will then determine what your overall procedure costs will be. Essentially, this is the time when your actual surgeon’s fees, anaesthesia fees and hospital fees can be calculated, so that you can receive your costs total.
Not only will this help you see how much of your costs Medicare can cover, but it will also prepare you for any additional fees that you will personally need to cover.
Contact us to arrange your consultation with Specialist Plastic Surgeon Dr Anh in Perth
We’re glad you’ve taken the time to learn a little more about breast reduction Medicare cover, how it can be granted, and what the process can typically involve.
Before starting the process, it’s common to have additional questions or to want to confirm any information related to your personal situation.
If you have any questions or would like assistance with arranging your consultation with Dr Anh, you are welcome to contact our team.
We are a phone call away at 08 9322 2659, or you can email us at enquiries@dranh.com.au or send an enquiry via our online form here.
