CHANGES to Medicare benefits have left Ruth Unni facing a bill of up to $20,000 if she goes ahead with the abdominal surgery recommended to ease her pain.
The Victoria Park resident has a hernia, cyst, severe back pain, incontinence and a bulging stomach caused by a 5cm separation of the abdominal muscles due to a pregnancy nine years ago.
A plastic surgeon recommended Mrs Unni have an abdomioplasty, or ‘tummy tuck’, for medical reasons at St John of God Subiaco to prevent hernias reoccurring.
The surgery was initially booked for February, but Mrs Unni postponed for financial reasons until June 17.
She planned to take a month out from her role as manager of a Fremantle psychology clinic for recovery, but cancelled the June surgery after a call from her surgeon’s office on May 17.
Mrs Unni was told then that Medicare’s rebate criteria had changed, leaving her liable for the full bill.
“I don’t fit the criteria because it is now weight-related, but weight was never my issue,” Mrs Unni said.
“If you lose 5 points off your BMI then you are entitled to surgery, otherwise not.”
Bupa confirmed the procedure must be eligible for a Medicare rebate to also be covered by health insurance.
AMA WA vice-president and plastic surgeon Mark Duncan-Smith said the Australian Society of Plastic Surgeons was lobbying the Federal Health Minister and Medicare for a review of the criteria.
He felt the crackdown on the item number was “overzealous” and in response to ‘Mummy Makeovers on Medicare’ advertised mainly by some surgeons interstate.
“It certainly is the AMA’s position that Medicare should not cover cosmetic surgery but in this situation there is a certain number of ladies who have functional problems… who do deserve to have the operation that are currently excluded by the new strict criteria,” Mr Duncan-Smith said.
He said the changes applied from January 1 but Medicare could cover patients with surgeries scheduled early in the year, under a moratorium with plastic surgeons.
Mrs Unni has contacted the Federal Health Department, and local politicians who then wrote letters on her behalf. Her surgeon has also appealed the decision.
A spokeswoman for the Federal Department of Health said the Medicare Benefits schedule for abdominoplasty was amended on January 1 this year.
“The amendments were made on the recommendation of the independent Medical Services Advisory Committee.
“The committee found that the benefits of abdominoplasty following pregnancy were largely cosmetic as diastasis recti (a widened the gap between the abdominal muscles) had no significant associated health consequences.”
She also said Mrs Unni’s case was unlikely to be reviewed.