Med­i­cal bill dif­fi­cult to stom­ach


Southern Gazette (South Perth) - - FRONT PAGE - Jaime Shurmer More, page 4

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.

Pic­ture: Marie Nirme­mu­ni­ d456267

Ruth Unni has a dif­fi­cult choice to make re­gard­ing the ab­dom­i­nal surgery that would ease her pain.

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