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Will Your Medical Insurance Cover Cosmetic Treatments?

Dr. Vi Sharma has worked in the field of cosmetic surgery

He has a Bachelor of Medicine & Bachelor of Surgery, Monash University; and former member of the Australasian College of Aesthetic Medicine and the Royal Australian College of General Practice.

You want to have cosmetic treatment, but can’t afford it? Will your private health fund cover your desired procedures? A significant consideration when it comes to getting cosmetic treatments is the cost. Knowing where you stand financially is one of the first things you should work out. 

To get insurance cover, the general rule of thumb is that a procedure must be deemed ‘necessary’ for health reasons and referred to as reconstructive surgery.

Currently, for payment plans, we accept ZipPay payments. Please make sure you register under the app and have your account approved before coming to the clinic for easier access. For more info please visit www.zippay.com.au for more details.

How to Determine if Your Insurance Covers Your Cosmetic Surgery

If you are considering a surgery, it is important to determine whether your insurance policy covers the procedure. Here are some steps to follow:

Check Your Insurance Policy

The first step is to carefully review the terms and conditions of your insurance policy to see which procedures are covered. Look for procedures that are deemed “necessary” for health reasons and referred to as reconstructive surgery. If the information is not clear, consult with your insurance provider.

Consult the Medicare Benefits Schedule (MBS)

The Medicare Benefits Schedule (MBS) is an online list of all the surgeries and treatments that are covered or subsidized by the Australian government. If your desired procedure is not on the MBS list and has no Medicare Item Number, it is unlikely that a private provider will pay out. However, if the process is listed, you can ask your private provider to contribute to the costs.

Know What Surgeries are Covered

Examples of reconstructive surgeries that are typically covered by insurance include cleft palate, skin grafts, scar treatment, facial reconstruction, and some necessary breast surgeries. For instance, if a woman has breast cancer and needs breast reconstruction involving implants, it is likely to be covered.

Understand Your Coverage

The amount of coverage for a surgery depends on your insurance policy and terms. Some treatments are deemed elective and therefore only partially covered by insurance, in which case you may need to make up the difference. The terms of your coverage might cover the doctor’s fees but not the costs of the theatre or other staff in attendance. When enquiring, make sure to ask if your Private Health Fund has a contractual relationship with a hospital. Going elsewhere could void coverage or increase personal cost.

Special Cases and Circumstances

It is always worth speaking to your provider in case of leniency or exceptional circumstances that might affect your ability to claim. For instance, mega liposuction, as offered at SKIN CLUB – Cosmetic Doctors Clinic, can remove up to 15 litres of fat. This procedure is a health requirement for patients who are morbidly obese. While it immediately shifts weight, it also places patients on the right track to start a new, healthy lifestyle including the ability to exercise which might previously have been impossible or too painful to consider.

is Your Medical Insurance Cover Cosmetic Treatments?

Cosmetic treatments like Botox, dermal fillers, and other non-invasive procedures have become increasingly popular over the years. While these treatments can help improve your appearance, many people wonder if their medical insurance will cover the costs. In this article, we will be discussing whether medical insurance covers cosmetic treatments and what you need to know before considering them.

Medical Necessity:

Medical insurance typically covers treatments that are considered medically necessary, such as those related to an injury or illness. Cosmetic treatments that are not considered medically necessary, such as Botox and dermal fillers for cosmetic purposes, are generally not covered by medical insurance.


There may be exceptions to this general rule, however. For example, if you have a medical condition like migraines or excessive sweating that can be treated with Botox, your medical insurance may cover the cost of the treatment. Additionally, some reconstructive surgeries like breast reconstruction after mastectomy may be covered by insurance.

Out-of-Pocket Costs:

If your medical insurance does not cover the cost of cosmetic treatments, you will likely need to pay for them out of pocket. The cost of these treatments can vary depending on several factors, including the type of treatment, the location of the clinic, and the qualifications and experience of the provider.

Financing Options:

If you cannot afford to pay for cosmetic treatments out of pocket, there may be financing options available. Some providers offer payment plans or financing options that can help make the treatments more affordable.

Choosing a Qualified Provider:

Whether or not your medical insurance covers cosmetic treatments, it’s important to choose a qualified provider who has experience performing the procedure. Providers who are more experienced or have advanced training may charge more for their services, but this can be worth it for the quality of care and results they provide.


While medical insurance typically does not cover cosmetic treatments like Botox and dermal fillers, there may be exceptions for medically necessary treatments or reconstructive surgeries. If your medical insurance does not cover the cost of these treatments, you will likely need to pay for them out of pocket. However, financing options and payment plans may be available to help make the treatments more affordable. By choosing a qualified provider and understanding your options, you can make an informed decision about whether cosmetic treatments are right for you.


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About Dr Vi

Dr Vi Sharma is a renowned and highly trained cosmetic surgeon in Sydney, practising cosmetic surgery since 2012. He has a worldwide loyal patient base. He has a bachelor of medicine and a Bachelor of Surgery from Monash University. Dr Vi Sharma is a former member of the Australasian College of Aesthetic Medicine and the Royal Australian College of General Practice. Along with treating patients, he also provides training for doctors and nurses regarding aesthetic and cosmetic treatment modalities.

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