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Medicare and Health Fund Rebates

In-hospital services

If you are a private patient in a public or private hospital, you will have a choice of practitioner to treat you. Medicare will pay 75 percent of the Medicare Schedule fee for services and procedures provided by the treating practitioner. Some or all of the outstanding balance can be covered by private health insurance if you are a member of a hospital fund. If your practitioner charges more than the Schedule fee, you will have to pay any charges in excess of the scheduled fee where there is a medicare item number for the procedure.

You will be charged for hospital accommodation and items such as theatre fees and medicines. These costs can also be covered by private health insurance for procedures where there is a Medicare item number.
 

What is not covered by Medicare?

Medicare does not cover such things as the following:

  • private patient hospital costs (for example, theatre fees or accommodation)
  • medical services which are not clinically necessary
  • surgery solely for cosmetic reasons

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    Aesthetic Day Surgery Procedures Covered by Medicare and Health Funds

    Medicare generally covers 75% of the scheduled fee for both the surgeons and anaesthetists fees for the following procedures.

    PROCEDURE CONDITIONS
    Breast Uplift Only in specific conditions
    Upper Eyelid Reduction Only if eyelids are obscuring vision
    Rhinoplasty Only for post traumatic deformity
    Tummy Tuck
    Correction of Bat Ears
    Breast Reconstruction
    Breast reduction
    Hand Surgery
    Skin Cancer Surgery

     

    As a general rule of thumb, those procedures that carry a ‘Medicare Item Number’ attract a hospital fund rebate of 25% of the scheduled fee for the surgeons and anaesthetist fees for in hospital services – such as those provided at the Aesthetic Day Surgery. However, an exception to this rule is if you have taken out cover with your fund that specifically excludes plastic surgery.

    The table highlights some of the procedures that do attract Medicare rebates and therefore are generally covered by hospital funds according to your level of cover.

    To confirm your exact level of cover, you will need to contact the staff at the Aesthetic Day Surgery or your relevant health insurance provider.