Health insurance for weight loss surgery

Yes, private health insurance can pay towards the cost of your weight loss surgery. With a Gold or sufficient Silver ‘plus’ or ‘+’ hospital policy, your health fund can pay towards the cost of surgery in a private hospital.

There are also some services that can be included on an extras cover policy, which may be beneficial depending on your circumstances.

Hospital cover

In Australia, hospital insurance can cover you for treatment as a private inpatient in a private or public hospital, provided the treatment is included on your policy, you’ve served your waiting periods and you have a referral from a healthcare professional. Your procedure must also be considered medically necessary by your doctor; this means your health fund will not pay for any cosmetic weight loss procedures that you choose for yourself.

When you’re treated as a private patient for a procedure included on your policy, Medicare will pay 75% of the Medicare Benefit Schedule (MBS) fee for your doctor/anaesthetist fees. Your health fund will then pay the remaining 25% of the MBS fee for your doctors, and some or all of the hospital fees (e.g. theatre fees, accommodation, medical devices).

While you might still have some out-of-pocket costs if your doctors charge above the MBS fee, they could be paid partially or in full by your health funds gap cover agreement.

Extras cover

While extra cover doesn’t pay towards hospital treatment, there are a few relevant out-of-hospital services that you might like to consider before or after your hospital stay. For example, you may be required to lose some weight before your doctors can safely operate; in which case, you might want an extras policy that includes cover for dietitians or gym memberships.

Here are some other extras services you might be interested in:

• Physiotherapy
• Non-PBS medication
• Weight management programs
• Quit smoking programs
• Psychology and counselling.

Yes, bariatric procedures can be covered by Medicare in a public hospital. However, since it’s an elective surgery, you’ll most likely need to serve a significant amount of time on a public waiting list before you can receive treatment. This is because waiting lists are prioritised based on the urgency of treatment, so if your weight doesn’t pose an immediate danger to your health, you may need to wait longer.

When you take out private health insurance or upgrade your policy, there are typically waiting periods you’ll need to serve before you can claim for your included services. For hospital cover, these waiting periods are 12 months for any treatment relating to a pre-existing condition (excluding rehabilitation, in-hospital psychiatric treatment and palliative care) and obstetrics, and 2 months for everything else.

However, many health funds will consider obesity as a pre-existing condition. This means that if a doctor could have reasonably diagnosed you with obesity before taking out cover, you will likely need to wait 12 months to claim.