Can I claim my Chin Surgery on Medicare?
Whether it is chin implant surgery or a genioplasty – chin augmentation or chin reduction chin surgery is a popular surgical and aesthetic procedure. Many patients often wonder about payment plans and whether Medicare or Private Health Insurance will cover their chin surgery. Just like other procedures that are partly functional and partly aesthetic, certain criteria must be met in order for medicare and your PHI to partially or fully cover the costs.
A Guide to Medicare and Health Insurance
Will Private Health Insurance (PHI) cover my Chin Surgery?
To be able to claim cover for your chin surgery by your private insurer, you must be eligible for a Medicare item number. However, as the terms vary from one health insurer to another, our recommendation is always that you contact your private insurer directly and discuss with them whether your level of cover can help with the cost of the operation.
In certain cases, it is also possible to apply for Early Release of Super Funds for Chin surgery. However, it should be noted, that this process requires compliance with certain ATO rules, and does not guarantee a super fund release.
Popular Reasons for wanting to have Chin Surgery
The beauty of the human face largely depends on the harmony of the facial lines, and one of the most important characteristics is precisely the shape and size of the chin/jaw. Patients opt for chin surgery for a variety of reasons, both aesthetic and health. The most common reasons for surgery are;
- Trauma or jaw injuries
- Congenital deformities
- And desire to achieve a more harmonious facial appearance.
Even though chin surgery is one of the more difficult plastic surgeries due to its longer physical and mental recovery and hospital stay, more and more patients are opting to undergo the procedure for health reasons.
Whilst fillers can provide minor corrections in the shape and size of the chin and is a non-invasive way to alter the chins appearance it may not give a satisfactory result for some patients, or alternately it may lead them to seek a more permanent solution.
Aesthetic Reasons for Chin Surgery
Often patients who opt for Chin Surgery are people who have congenital defects such as improper facial symmetry, prevention of tooth wear or repairing the effects of ageing.
Aesthetically, the most common reason patients decide to have chin surgery is to correct macrogeny (large chin) and microgeny (small chin). The correct symmetry of the face is when, looking from the profile, the chin is levelled with the “filter” (the junction of the nose and upper lip).
Some of the downsides in this case are:
- Asymmetrical facial appearance
- The so-called “witch’s” profile
- Unattractive appearance
- Saggy chin skin caused by ageing
Functional Reasons for Chin Surgery
In addition to aesthetic reasons, patients often opt for Chin Surgery for functional/health reasons, in order to facilitate and improve the quality of life.
The reasons for Chin surgery can be:
- Solving bite problems
- Removal of the consequences of injuries
- Resolving a congenital condition such as the cleft palate
- Facilitating chewing, biting, and swallowing
- Help with breathing problems and obstructive sleep apnea
- Reduction of pain due to temporomandibular joint disorders
How Do I Qualify for the Medicare Rebate?
In order to be a suitable candidate to secure rebates through Medicare, you must meet strict requirements. The Australian Government uses a numbered list of services through the Medicare Benefits Schedule (MBS) to determine which procedures are subject to rebates.
GENIOPLASTY including transposition of nerves and vessels and bone grafts taken from the same site falls under the fourth category of procedures-Oral And Maxillofacial Services, as well as FOREIGN IMPLANT (NON-BIOLOGICAL), insertion of, for CONTOUR RECONSTRUCTION of pathological deformity, not being a service associated with a service to which item 52624 applies.
MBS Code for GENIOPLASTY surgery is:
52378 – GENIOPLASTY including transposition of nerves and vessels and bone grafts taken from the same site
Genioplasty attracts benefit once only although a section is made on both sides of the symphysis of the mandible.
MBS Code for CHIN IMPLANT surgery is:
52321 – FOREIGN IMPLANT
Full MBS Item Number breakdown and description:
FOREIGN IMPLANT (NON-BIOLOGICAL), insertion of, for CONTOUR RECONSTRUCTION of pathological deformity, not being a service associated with a service to which item 52624 applies
Will Medicare Cover Chin Surgery for medical reasons?
The basic rule, both Medicare and PHI, is that aesthetic procedures are not subject to any rebates. However, as is often the case with patients considering chin surgery, if your problem is not only aesthetic but a matter of health, including day to day living and reduced quality of life, then there is a possibility that your insurer will, at least to some extent, fund your intervention.
Such a request must be medically justified and necessary.
The specific criteria for Genioplasty Surgery are:
- Genioplasty attracts benefit once only although a section is made on both sides of the symphysis of the mandible.
- 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 Chin 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
A Guide to Medicare and Health Insurance
Why is Medicare for Chin Surgery confusing a lot of patients seeking Plastic or Cosmetic Surgery?
Like any other surgery, plastic surgery varies from situation to situation, from patient to patient. If you are considering chin surgery, it is important that you know some basic settings and principles by which Medicare works.
Some patients opt for plastic surgery solely for aesthetic reasons, to make improvements in their physical appearance, while for others plastic surgery is a necessary endeavour to facilitate their daily functioning and ensure a normal life. That is why it is important to know that procedures that are only aesthetic are not subject to rebates. However, if your medical problem is of such a nature that it makes it difficult for you to function daily, there is a possibility that a certain percentage of your costs will be covered by Medicare.
Life-Changing Effects of Chin Surgery
Chin surgery is a rather difficult operation after which the patient must be in the hospital for a few days. Recovery can be painful and long, and it is necessary for patients to strictly follow doctor’s instructions regarding oral hygiene and eating.
As the face is the most exposed part of the human body and the changes on the face after chin surgery are obvious, most patients are extremely satisfied with the results of chin surgery. These are most often patients for whom the discrepancy between the chin and the rest of the face is a hindrance from birth and greatly affects their self-confidence. With chin surgery, such patients achieve facial harmony, and the complete impression of their face changes in a way that they look more harmonious and without rough lines.
As previously mentioned, there are several health problems that are solved by chin surgery, and after the operation patients get rid of pain, breathing problems and find it is easier to swallow and chew.
Correction of the chin 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 Chin 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
- When thinking about undergoing plastic surgery and finding out about the possibilities of whether your procedure is subject to rebates, you must first know that your procedure is not subject to rebates if the procedure is only aesthetic – cosmetic surgery.
- On the other hand, if it is plastic reconstructive surgery, there is a good chance that your procedure will be financially covered at least to a certain extent, either through Medicare or PHI.
- So, if you decide to have the procedure only for aesthetic reasons, your request for rebates will almost certainly be denied.
- PHI and Medicare do not cover the same procedures or to the same extent. Therefore, before the operation, be well informed about the conditions and scope under which the operation can be covered by Medicare, and under which by a private insurance provider.
- In your request;
- Be as precise as possible
- Describe your problem in detail
- Support everything with photos, medical records, and medical findings.
- Learn all about MBS codes. Read the descriptions in detail and try to understand what you have read.
Further Tips For Your Chin Surgery
- Every plastic surgery begins with an examination and consultation with a plastic surgeon.
- Before chin surgery, it is necessary to perform a facial MSCT to determine a jaw correction plan. There are several methods used in jaw surgery, and depending on your condition as well as your preferences, with the plastic surgeon you will choose the most appropriate method for you.
- After the operation, you will be told to;
- Consume a liquid diet
- And, sleep on your back. This reduces jaw movement and unnecessary pressure.
- It is very important that you ask your doctor for a written confirmation/referral to undergo surgery for health, not aesthetic reasons.
- The referral of a general practitioner is valid for 12 months
- and specialists for only 3 months.
- Keep this in mind so you don’t miss deadlines.
- Never sign up for multiple procedures at once. Such requests usually result in rejection.
- Ask your doctor to show you photos of other patients with the same problem before and after surgery.
When phoning Medicare and Health funds
- The Medicare rebate application process will take some time and can be very stressful.
- We recommend that you communicate with agents by email so that you have a written record of any information exchanges
- If you do use the telephone, ask the agent for a written confirmation of the interview at the end of each call
- Throughout the refund application process;
- Record all the information you receive
- Organisation is key
- Keep all the documentation related to the procedure and refund application, preferably in chronological order.
- 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.