Again and again we are asked: “Does the health insurance cover my surgery at a private surgery/optional doctor or my procedure, if so how much is paid and how does the submission work?”
Since Austria has a very good health care system, almost all people residing in Austria are compulsorily insured and are entitled to mostly free treatment by a panel doctor. The situation is different with so-called elective doctors or private doctors. These treat their patients for a fee. In some cases, the costs can be submitted to a private supplementary insurance and the health insurance company.
Which treatment is considered medically necessary depends on the insurance and in some cases also on the federal state. Clarification of this should ideally take place before treatment. The health insurance company will communicate directly to the patient whether it will cover the costs and to what extent.
the aesthetics is a private practice, Dr. Rolf Bartsch and Dr. Katrin Bartsch are elective doctors. This means that there are no contracts with a health insurance company, the costs of treatment are to be borne by the patient. Nevertheless, there are some procedures which, depending on the diagnosis, are considered “medically necessary”.
WHICH TREATMENTS AT THEAESTHETICS CAN BE COVERED BY HEALTH INSURANCE?
The aesthetics offer various treatments that also alleviate medical causes. For example, botulinum toxin is also used in aesthetic medicine for hyperhidrosis (excessive sweating) and migraines. Fillers can also be used to treat scars and facial asymmetries after accidents. In plastic surgery, the correction of asymmetrical breast shapes such as tubular breasts, very large breasts (breast reduction) or deformed breasts can often be “medically necessary”. Drooping upper eyelids, so-called drooping eyelids, which restrict the field of vision can also fall under medical correction if they are severe.
The following treatments can be covered by health insurance in individual cases:
- Botulinum toxin for migraines
- Botox against sweating (hyperhidrosis)
- Reconstruction of the tubular breast/breast malformation/breast cancer
- Breast reduction (mammareductionplasty)
- Labiaplasty (labiaplasty)
- Eyelid lifting in cases of visual field impairment diagnosed by an ophthalmologist
- Removal of skin tumours such as moles and atheromas
Which prerequisites and to what extent these must be present depends on the respective health insurance fund. Findings, psychological reports, X-rays, etc. can be requested by the health insurance fund.
THIS IS HOW THE PROCESS OF SUBMITTING A CLAIM FOR COST COVERAGE WORKS:
Consultation and clarification with Dr. Rolf Bartsch or Dr. Katrin Bartsch, application for approval to the health insurance fund.
Request for health insurance
Clarification: Will my desired treatment be covered by the health insurance, if so, in full or in part?
Submit to the health insurance fund
Submit the expert opinion of the specialist, the expert opinion of the surgery and the cost estimate to the relevant health insurance fund. This is usually followed by an assessment by a responsible chief physician of the regional health insurance fund. The health insurance company will then contact you with information on the amount of the costs to be covered.
Once the assumption of costs has been clarified, the planning of the operation takes place. The confirmation of the assumption of costs must be available at the time of the registration for the operation; the assumption of costs is no longer possible at a later date.
Holders of supplementary insurance can submit the costs to their private insurance company and, in the best case, be reimbursed there. However, it is important to first submit the treatment cost plan to the compulsory insurance such as ÖGK, BVA or similar.
How high are the costs that are reimbursed?
The compulsory insurances usually reimburse only a part of the costs. For breast surgery, for example, the average amount is 1,600€. If you also have private supplementary insurance, the amount to be reimbursed will be higher.
It is important to clarify this BEFORE a possible operation.
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