Capping Medicare Saftey Net for IVF/ART

Thanks for that link Dusty. I've also grabbed the Age, Sun and Fin Review to see if they have anything in their print editions...now I just need to find time to read it all...

I really can't believe how dramatic these cuts are - they are completely out of touch with how difficult this journey is to begin with ...

I still can't get over how many times they mention "family" while effectively taking away from so many the ability to create a family.

In the US, cycles run about US$20-25,000. People take 2nd mortgages on their home and go into debt for years and years - is this what they want to happen here?

There is very little news/reporting on this issue. I expect things will become clearer over the coming days.

As I understand it, Medicare will still pay for the same proportion of your cycle as they have to date. The difference (which some clinics charge as their upfront fee) will only be supported up to $550.

So for Monash IVF I pay $5500 up front for a donor cycle, Medicare pay the clinic the difference in the fee directly to them and I will get $550 of the $5500 back :redface:

:o I get it - so the $4400.00 mivf charges for a basic stim cycle - I will be out of pocket $3850.00 + everything else on top per cycle .

And for those who need, pgd, isci and/or donor, there are more out of pocket charges

Sorry, I sent my letter off when this started, but I put my head in the sand, until the budget was released, it's only now I understand :redface:

Ok, I rang the Health Minister's office Nicola Roxon. They didn't know the answer (yet!). I rang the Health Department and they are going to ring me back soon (I hope). Seems there isn't much information available (yet!).

If you want to put a bit of pressure on them to find the information we desparately need

Ring Roxon's office - 02 6277 7220
and/or
Health Department - 1 800 020 103

I suggestion you say you have heard that caps to the Medicare Safety Net have been announced for assisted reproductive technology treatments and you would like to know what those caps are and what it means for someone undergoing IVF/ICSI etc. Also worth finding out if they have upped the Medicare rebates for IVF (separate to the Safety Net).

Posted by another BB member OriginalP...

I'll do some research today to see exactly what the cap means. I may raise hell about it as whatever it is, I'm sure it's discriminatory to women and therefore unconstituional. I believe the Government can only get away with it if there is some balancing cap on treatment for men...

I am just really angry of those clinics (including mine) who started charging excessive fee because they think they can...otherwise wounldn't bring too much attention of cutting this part of the services of Saftey net. The worst part is WE are the victims at the end of the day. The new cap figures are just a joke, so much worse than what I had in mind, I was thinking something like $5000. How wrong was I? I didn't even bother trying to work it out how much I can get, pretty much close to nothing anyway.

I am like Sara, 1 Jan 2010 will just have to be the end of my TTC journey...

Brilliant idea to call...I am doing so now - after they transferred me around, I spoke to someone who told me that the numbers are not final. That negotiations (??) are going to take place between the government and the ivf professionals to determine the final numbers. She said that it is expected that these negotiations would take months and the outcome would be available through MBS Online - Welcome to MBS Online.

She went on to say that people who are charged the medium (I believe she used the word "medium" as opposed to mean or average - I can't remember my maths though so I'm not sure what this means!), are not expected to be worse off. I told her that this doesn't sound right, because based on the prices being charged by the major clinics in Sydney and Melbourne, we would definitely be worse off. She said, "write to our office (Nixon) and your Ministers".

So, it sounds like a major letter campaign is in order - there's still time to be heard!

Dont ring the 02 number, he does not know how to help

I have been passed from pillar to post in the Health Department,

MBS - Medical Benifets is going to call me back - I go through to the budgets people, they said I need to speak to the policy people ..

It was someone in Nixon's office who gave me the info (don't know who or what dept..but it took a number of transfers).

The health dept took my info and said they will call back.

Thanks for the numbers Dusty

Hi BullieJ, Nixons office puts you through to the Health Dept, who transferes you around. Then it seems we leave a message for a call back.

Hi everyone,

this has been really informative. Thanks for your efforts in getting info on exactly what this means. I'm also shocked at how bad the cut backs are and find it very discriminative. It's amazing how little detail there is from the govt. on something so important to the people they are impacting. Doesn't it feel dismissive?

There'll be heaps of negotiation with the libs and independent senators to get the budget bill through parliament. I've emailed them to apply some pressure. The media coverage this morning has brushed over the IVF and safety net issue which is really disappointing.

I have tried calling the numbers but it seems they are coping with "larger than expected amounts of calls" lol. Hardly suprising!

What are our options here as far as getting this load of C##P chucked out? Would a nationwide petition do any good?

I am going to call the Human Rights Commission today and ask to speak to someone in their legal team.

I do believe they want IVF to be like it is in America and New Zealand. A luxury only available to the rich or those who have a house to morgage.

This on top of getting my BFN yesterday. Its almost to much.

Are there people we can write to and lobby? I am not a LTTTC/ACer but would dearly love to do whatever I can to fight - this is simply unjust.

I wrote in the first round (ie when it was 'rumour') but am not sure what else I can do... if you guys can provide direction I will gladly lobby, email, phone etc whomever is needed

Sammy :hug: Sorry to hear about your BFN. Good on you to cal the Human Rights Commission. I think we need to make as much noise as possible.

Sara

Hi everyone,

this has been really informative. Thanks for your efforts in getting info on exactly what this means. I'm also shocked at how bad the cut backs are and find it very discriminative. It's amazing how little detail there is from the govt. on something so important to the people they are impacting. Doesn't it feel dismissive?

There'll be heaps of negotiation with the libs and independent senators to get the budget bill through parliament. I've emailed them to apply some pressure. The media coverage this morning has brushed over the IVF and safety net issue which is really disappointing.

H.Dept called me back, I have to go into a meeting, so cant post a long one, so hopefully they call you guys while I am gone.

It's all about the cap on the planning and management fee, he said we wont be worse off, we need to find out and shop around for what clinic has the cheapest planning and management fee item numbers. they are meeting with ivf head honcho's tommorow, and clinics need to come to the party and reduce their planning and manage fees.

I think he was trying to gloss over it though, and the clients had arrived, so I had no privacy to continue with the info.


IVF clinics wont have the answers, he does not expect till Sept or Oct .

This is the only narrative I can find so far. Note the line I've bolded...

From January 1, 2010, safety net payments will be capped at $200 for the planning and management of a pregnancy, $30 for a pregnancy consultation and $550 for the planning and management of an IVF pregnancy.

The Government will introduce a cap on Medicare benefits payable under the Extended Medicare Safety Net for a range of items with excessive fees including all obstetric items and some ultrasound items related to pregnancy. At the same time, the scheduled fees for the obstetrics items will also be increased from 1 January 2010, benefiting patients particularly in rural and regional areas.

The Extended Medicare Safety Net was introduced in the 2003‑04 Budget. In 2008, expenditure on the Extended Medicare Safety Net was $414.1 million, an increase of 29.7 per cent from the previous year, with obstetrics‑related items accounting for 30 per cent of all expenditure.

There is evidence that the Extended Medicare Safety Net has enabled some doctors to charge excessive fees, resulting in windfalls being paid by taxpayers through Medicare. The cap will encourage patients whose doctors charge excessive fees to seek other providers who charge more reasonable fees.
The capping of the obstetric items will achieve savings of $351.3 million over four years and the increase in schedule fees will cost the Government $157.6 million over four years. The measure will provide net savings of $193.7 million over four years.

See also the related savings measure titled Medicare Benefits Schedule ? capping Extended Medicare Safety Net benefits for items with excessive fees and Improving Maternity Services Package in the Health and Aging portfolio.

I would like Nicola Roxon to explain to KK in Cairns how this measure is going to support her to choose a different FS when there's only one in town. Sheesh!!!

Is there anyone else out there that got charge that stupid $32.50 fee to have their partner sit next to them in the FS rooms? Because I did. And I think that was a total rort.

OP.

ok, if ONLY the planning and management fee is to be capped, and the "medical" side of things is to be left as it is at the moment, it may not be AS bad as it seems. i have just looked up my medicare history online for IUI's last year and found we got charged a little over $700 for the planning and management - if it's capped at $550 PER CYCLE and charges are along this vein, but you still get the other charges rebated as you have been, it makes it more tolerable. unfortunately i can't look at my medicare claims history going back to full IVF cycle but if anyone else can, it may help to see what the impact is going to be

i think this is going to be a very "murky" for a few months, but just wanted to pop my head in and say if they ONLY cap the pay out on the planning and management fee (which is the bit the doctors manage to bump up all the time) then it may not be "as bad" as it firstly seemed. still bites, but if it is ONE number being impacted, not all of them, it's going to be not as bad as it seemed. for me, that code was 13209... i don't know if the code is different for IVF than it was for IUI - if that is the only one being capped though, it may not prevent us trying again in the future... if all codes are being capped, there is no chance in hell we'll be able to afford it for at least a few more years...