Medibank and the Australian Society of Plastic Surgeons have today announced a landmark agreement for plastic surgery health insurance claims.
This agreement aims to ensure that only medically necessary plastic surgery procedures are covered by private health insurance and not cosmetic surgery, as set out legislation, which applies to all private health insurers.
The process strikes a balance between Medibank’s concerns about funding inappropriate surgery and surgeons’ concerns for certainty of care for their patients. It also makes it easier for Medibank’s policyholders to get treatment and provides clarity of coverage for medically necessary plastic surgery procedures.
Dr Tony Kane, President of the Australian Society of Plastic Surgeons, says, “Our patients were struck by the lack of certainty the original eligibility checking process created. We were determined to find a solution to give our patients certainty of cover as many of our patients have been left confused in recent months.”
Dr Andrew Wilson, Medibank Executive General Manager of Provider Relations and Integrated Care, stated, “We are pleased to confirm our agreement with the Australian Society of Plastic Surgeons. Medibank has always covered eligible patients for plastic surgery, where it is for legitimate medical reasons and we will continue to do so.
“However, as this area of surgery is unique and procedures such as eyelid surgery and breast augmentation can be performed either for purely cosmetic or for quite legitimate medical reasons, it is essential that we have a robust process to ensure we are paying the correct claims on behalf of our policyholders.”
Dr Wilson continues, “Critically, Medibank has never had any intention of weakening or interfering in the doctor-patient relationship. Through this process, we can ensure that we keep quality healthcare affordable for our policyholders.”
Dr Kane summarises, "By each party stating their concerns clearly and showing a willingness to listen and compromise we have engineered a sensible solution to improve our, at times overly criticised, health system."