Can I claim my Thigh Lift on Medicare?
As the Thigh Lift is one of the most popular surgical and aesthetic procedures, many patients often have inquiries regarding the financing of such an operation. But as with other procedures that are borderline functional and aesthetic, certain rules must be met in order for your insurance provider to partially or fully cover the costs.
Will Private Health Insurance (PHI) cover Thigh Lift Surgery?
In order to be able to perform a thigh lift operation through your private insurance, it is essential that you meet the requirements set for the Medicare case number.
To find out everything you are interested in regarding the application process, who, under what conditions, and in what proportion can claim reimbursement, it is best to contact your insurer.
In certain cases, it is possible to apply for Early Release of Super Funds for Thigh Lift surgery. However, note that this process requires compliance with certain government rules, and does not guarantee a fund release, especially in the cases when the surgery is requested for aesthetic reasons.
Popular Reasons for wanting to have Thigh Lift Surgery
Thigh surgery is most often performed on women in their 40s. The reason for this is the loss of the tightened appearance of the skin of the thighs, which can be the result of ageing, sudden and large weight loss, and pregnancy.
And while the vast majority of aesthetic flaws today can be covered with makeup or some less invasive procedures, achieving the appearance of perfectly smoothed, youthful thighs is not one of those cases.
Diet, large amounts of fluids, regular exercise, or various massages and treatments are simply not enough in some cases. Some patients have an irreparable loss of tissue tone that cannot be smoothed out except by surgical removal of excess tissue.
Thigh lift surgery is performed under general anesthesia in such a way that the sagging tissue is removed from the upper side of the thigh to the knee.
Aesthetic Reasons for Thigh Lift Surgery
Why do women most often opt for thigh lift surgery?
Women’s legs are a symbol of elegance and sex appeal, so an increasing number of women decide to have the operation of lifting and tightening. Today, women often perform buttock surgery and buttock lifting at the same time, which completely transforms the lower part of the body.
Often patients who opt for Thigh Lift are people who have gone through massive weight loss, which leaves them with excess skin that they cannot solve with non-surgical methods.
Also, patients are often women who, after pregnancy, and especially several pregnancies, can no longer achieve the appearance of the thighs as they had before pregnancy.
Some of the downsides in this case are:
- Limp and saggy thigh appearance
- Unattractive appearance
- Excess skin due to loss of tone caused by aging or pregnancy
Functional Reasons for Thigh Lift Surgery
In addition to aesthetic reasons, patients can opt for Thigh Lift Surgery for functional reasons, in order to facilitate and improve the quality of life.
For example, in cases where patients have experienced significant weight loss, the excess skin on the thighs after weight loss can significantly complicate their daily movement.
The reasons for cosmetic surgery Thigh Lift can be:
- Often the excess skin left after weight loss negatively affects the mental state of the patient because it constantly reminds him of the obese state in which he was
- Excess skin and adipose tissue that significantly reduces body function and normal functioning
- Women who are left with excess skin after pregnancy often suffer from a lack of self-confidence and are more prone to depression and introversion.
How Do I Qualify for the Medicare Rebate?
To qualify for a rebate for thigh lift surgery from Medicare, the circumstances of your case must meet certain criteria.
The Australian Government’s Medicare benefits program contains a list of services subject to rebates.
Lipectomy for lifting the thighs is in the third category of procedures – therapeutic procedures and a subgroup of general surgery.
MBS Code for Thigh Lift surgery is:
30179 – Circumferential lipectomy
Full MBS Item Number breakdown and description:
Circumferential lipectomy, as an independent procedure, to correct circumferential excess of redundant skin and fat that is a direct consequence of significant weight loss, with or without a radical abdominoplasty (Pitanguy type or similar), not being a service associated with a service to which item 30165, 30168, 30171, 30172, 30176, 30177, 45530, 45564 or 45565 applies, if:
- the circumferential excess of redundant skin and fat is complicated by intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or nonsurgical) treatment; and
- the circumferential excess of redundant skin and fat interferes with the activities of daily living; and
- the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy.
For more information, you can download our Medicare and Health Insurance Guide!
Will Medicare Cover Thigh Surgery for medical reasons?
PHI and Medicare operate on the principle that they do not apply to aesthetic procedures, i.e. that aesthetic procedures are not acceptable for rebates.
However, if, in addition to aesthetics, in your case, there is a need to solve a certain health problem that interferes with you or makes it difficult for you to function daily, then there is a possibility that your insurer will finance your medical procedure.
Such a procedure must be medically justified and necessary and under specific Medicare criteria.
The specific criteria for Thigh Lift Surgery are:
- The surgery is not intended as a primary bariatric procedure to correct obesity. MBS benefits are not available for surgery performed for cosmetic purposes.
- For the purpose of informing patient eligibility for lipectomy items (30179) that are for the management of significant weight loss (SWL), SWL is defined as a weight loss equivalent of at least five BMI units.
- Weight must be stable for at least six months following significant weight loss prior to lipectomy.
- For significant weight loss that has occurred following pregnancy, the products of conception must not be included in the calculation of baseline weight to measure weight loss against.
In every other case, neither Medicare nor private health insurance will not cover the costs.
Research to find out if Medicare and the MBS Covers Your Thigh Lift Surgery Procedure
- You can download a complete MBS benefits scheme to find out more about the categorization, codes, and conditions for each procedure.
- If you are looking for a specific procedure, you can use a built-in search function to browse through the categorization faster
- If the desired procedure is not listed in the MBS categorization, Medicare is not offering reimbursement for that specific surgery
Thinking about getting Thigh Lift Surgery? Download the Thigh Lift guide!
Before you go in search of information related to the financing of the operation itself, it is important to read everything related to the desired procedure.
Why is Medicare for Thigh Lift Surgery confusing a lot of patients seeking Plastic or Cosmetic Surgery?
Each plastic surgery procedure is strictly individualized and modified for each patient.
Accordingly, all patients are different and come up with different ideas and qualifications for the procedure.
Some opt for procedures because they want to improve their physical appearance, while others seek surgical help due to certain problems that create obstacles in normal functioning and living.
Precisely for this reason, it seems to many that Medicare, but also private health insurance providers, are too strict and require seemingly unfulfillable conditions.
But although the whole process is quite complicated, and often time-consuming, the general rules are very clear: Esthetic surgery is not applicable for rebates.
However, if you have described complications that can cause a certain degree of deformity, and you meet other additional conditions, there is a possibility that Medicare will cover a certain percentage of the costs of your procedure.
Life-Changing Effects of Thigh Lift Surgery
Excess skin and adipose tissue in the area of the thighs, as already mentioned, can be a great aesthetic and psychological burden.
This problem most often occurs with age, after significant weight loss or pregnancy, especially after multiple pregnancies.
Unfortunately, the problem of excess skin cannot be significantly solved with exercise and various cosmetic treatments. In some cases, liposuction can help to some extent, but as this procedure only removes adipose tissue, the problem of sagging skin remains, especially after significant weight loss.
In some patients, excess skin and adipose tissue in the thigh area can also cause various health problems, so people with this problem especially complain of irritative dermatitis (inflammation of the skin) in the thigh area which causes sores, irritation, and pain, making their daily activities difficult.
Correction of the thigh skin is a very effective procedure, which results in a high level of patient satisfaction.
To view more before and after images, you can visit the Thigh Lift Surgery photo gallery here.
Medicare Rebates are subject to change and review
MBS Item codes can change or be eliminated from the Medicare rebate schedule. If your surgery is currently eligible for a Medicare rebate, it may be best to perform your procedure sooner rather than later.
Top Tips for dealing with Medicare regarding your claim
- First of all, it is necessary to distinguish plastic surgery from cosmetic surgery, which two terms are often, erroneously, equated in a speech today. Plastic surgery, when it meets certain conditions, is subject to rebates while cosmetic surgery is never.
- Medically justified plastic surgery, i.e. the necessary one, is called reconstructive plastic surgery and if your procedure is a reconstructive procedure, it is very likely that in that case the procedure will not be fully financially compensated.
- If your procedure is only aesthetic, then you will surely be rejected with a request for rebates.
- Medicare and PHI do not have the same extent of services, so before undergoing any surgery, inquire about differences in service.
- If you decide to request rebates, make your request as precise and reasoned as possible, and follow the MBS provisions and follow the changes to the provisions that are frequent.
- Make photos (from the more angles the better) as well as your medical record an integral part of your request.
- Learn what the terms “medically indicated” and “Statement of benefit” refers to
Further Tips For Claiming Your Thigh Lift Surgery
Before each operation, including thigh lift surgery, it is necessary to make a detailed consultation with a plastic surgeon.
Regardless of the specifics of your situation and health condition, you may need to have consultations several times before the procedure.
If you decide to have surgery for health reasons, make sure your doctor gives you a written confirmation.
When choosing a doctor, make sure that it is a plastic surgeon, not a cosmetic surgeon.
If you receive a referral from a doctor, make sure that the referral from a doctor is valid for 12 months, while a referral from a specialist is valid for 3 months.
When phoning Medicare and Health funds
- Be prepared that the entire Medicare rebate application process can be exhausting and quite time-consuming.
- We recommend that you do all communication via email, as you will have a written trace for each exchange of information, but if you decide to call, make sure that after every conversation the agent provides you with written confirmation
- Throughout the process, record all the steps you have taken and the information you have received.
Unfortunately, CocoRuby doesn’t provide assistance with Medicare or Health Fund processing.
This is solely the patient’s responsibility.
However, we do list the Medicare code(s) on your Quote and on your Invoice(s). So, if you are eligible for a Medicare rebate code or health fund rebate, this can help you when it comes to submitting your paperwork.
More Information about Your Procedure
You can Download Free Procedure Guides on your chosen surgery.
Also, our FAQs page might help you find out more about the procedure you are interested in, and other patients’ experience.
For more information about pricing and payment methods, please visit our page on Surgery Payment options.
You can also talk to our Patient Care Team from 8 am – 6 pm Monday to Friday on 1300 264 811
Phone 1300 264 811 or send us an enquiry form, below.
*Disclaimer: Individual results can vary significantly from patient to patient. The information we provide is general. For further information on what to expect for your preferred procedures, arrange to see one of our Specialist Plastic Surgeons for a full-history and surgical consultation. Read further information about surgical outcome variability on our Disclaimer page.