For many procedures, including breast reduction or tummy tucks, health insurance can have a big impact on the cost.

Dr Gahankari and our team are often asked who we recommend for health insurance. We are not at liberty to advise any patient on a health fund, as that decision depends on your personal circumstances. But here are a few things to consider:

12 month waiting period: Most funds require at least 12 months of membership before covering procedures so you may be best to secure that before you see our surgeons to make sure that your goals and health are assessed closer to the time that you may be able to have surgery. Things can change a lot in 12 months!

What does the policy cover?: It is also important to make sure your health fund covers the procedure you are considering, so you need to specifically ask if they cover the Medicare item numbers of the surgery you are looking at. Most of these item numbers are listed under the FAQs for the procedures we have on this website.

Comparing funds: In Australia, many funds are run to benefit members, but some like NIB and Medibank are listed companies, which have a legal obligation to maximise profits for shareholders. This sometimes results in below-industry rebate ratios for their policy holders. One independent source for comparing funds is the government website www.privatehealth.gov.au. It allows you to look at funds you are considering and then assess their pay-out ratios (how much they pay to policy holders vs the premiums they collect).

Things to consider regarding “no-gap”
As health costs rise across the population, some health care funds are putting pressure on doctors to accept, “no-gap” or “medi-gap” payments. Some patients, when they question their fund on why – after decades of paying premiums – their rebates are so low, are told that the doctor should be accepting, “no-gap”. So they are pushing the blame for the low rebate back on the doctor.

The reality is that modern Specialist medical practices simply can’t afford to run on the “no-gap” payments alone which are in some cases less than 40% of the fees recommended by the Australian Medical Association.

The cost of running a clinic is considerable – employing nurses and reception teams, and paying the large insurance policies are just part of what goes into the cost of a patient’s surgery. We do not want to be forced into the American model of health care where money dictates what services will be provided to policy-holders as this is the best outcome for patients.

If you believe your rebate is too low and your fund should be paying more of your medical expenses, we urge you to consider looking into another fund which pays larger rebates.

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