Capping Medicare Saftey Net for IVF/ART

The budget is done and dusted and at the printers as we speak.

So now we just wait. Sara is right - there will most likely be plenty of leaks in the coming days - watch out for Friday afternoon - it is the night that noone watches the news!

It is going to hurt - the question is how much.

On the up-side, it would seem that Mr Turnbull is quite wedded to universal health care and they need the opposition to pass it in the Senate. Just because something is in the budget doesn't mean that it will actually happen.

But I feel that I am going to be screwed no matter what and it is now my patriotic duty to make every effort to minimise the tax I pay - they clearly don't know what to do with it.

I won't be able to catch the news on Friday night...if someone does, can you post an update.

I have a bad feeling too. I reallllllllllly hope I am proven wrong.
BUT, even if they bring down a bad outcome for IVF we can still make ourselves heard and try and change the outcome. How to get the general community's support, who haven't faced or experienced infertility in their lives, may be a challenge. Bec good on you for putting your story out there :clap:. I feel it is the real stories like yours that will influence attitudes.

Ok - this is what the news is reporting this morning...

In a nut shell:
* there will be no means testing
* actual medicare rebates for obstetrics and IVF (along with a few other things) will go up
* there will be a cap on the amount that you can claim on the safety net

So, the rebates that everyone gets for the items (regardless of whether you have reached the safety net or not) will go up (no idea how much) and there will still be some form of safety net but not as it currently is - presumably a maximum amount each year - a bit like items on health insurance.

Stay tuned for more info once the media all get hold of it - so far I can only see it in the SMH and I heard a little snippit on early AM on the ABC - I will be listening to the full AM at 8:00.

The Ob interviewed on AM said that about 80% of women who use Obs will be worse off.

Front page of the Age also carried similiar info - maybe worth checking out online?

Talk about disappointing - although may be best to see what the detail is on Tuesday....(trying to stay hopeful). :rolleyes:

Crackdown on doctor rorts | theage.com.au

So it seems they are going to try to influence the amount the IVF clinic charges by reducing the amount patients can claim under the medicare safety net.

If the safety net created a rort/incentive for clinics and specialists to increase their charges, why not regulate how much the clinics and specialists can charge rather than penalise patients that access the clinics and who have to depend on what the clinics decide to charge. I dunno seems like they 'hope' this will reduce the prices clinics charge.

Yep - link on front page of the Age online. No real info there, sounds like everything Muppity said is true, but the cap on the safety net will be a cap for specific items like ivf and ob fees. Of course, the last line of the article is that these changes haven't been confirmed or denied by the government. I wonder what the cap will be and how many cycles it will translate into in terms of cycles where you get some money back and cycles where you don't.

My reading is that this will, to some extent, limit the number of cycles people will do in a fiscal year - if it is a reasonable limit, well, I guess compared to what could have happened, I will begrudgingly say OK. But if it's like 2 cycles, that will really stink.

In some ways I could see a LIFETIME cap on cycles in terms of safety net (or cap per live birth and once you have a live birth you go back to zero and get to access the safety net again) IF it is a realistic cap (representative of the average number of cycles & has some correlation to how long it takes people who don't need AC etc). I can understand how the safety net may not discourage people to do a crazy number of cycles which the government has to pay for.....and this is coming from someone who has already gone through 4 cycles and expects to have to do a few more and will in fact do a crazy number if that is what it takes or until I just call it quits.

Dusty - there seems to be little focus on the drs and the clinics - I wonder if that's because they have no power to control anything they do (although they sure exercise their power when it comes to rules about how many embryos/police checks (state rules)/etc....seems like they are as powerless as they are in terms of forcing the banks to pass on interest rate cuts. And little focus on investment in how to improve success rates of IVF - now wouldn't that be great!

Julie, that is food for thought about limiting cycles. In a way depending on how and what the limit on claims under the Safety Net becomes, they could essentially be limiting the amount of cycles you can do under Medicare/Safety Net in a financial year. And depending on where you live, there may be no competition between clinics (eg only one in a region) and hence the price of cycles may remain high and limit the amount someone can do in a region compaired to a city where there is more competition and perhaps downward pressure on prices. Hence someone in a city may be able to squeeze more (cheaper) cycles in than someone in the country/regional area.

I think they are leaking this info out now to see what the reaction is from the community before next week's budget.

Time to email/ring/fax the Treasurer and PM again I reckon with outrage at any limit to the number of cycles we can access under a reduced/limited Safety Net. Why should we suffer because of the impact of the greed of corporate IVF clinics and their shareholders.

The Hon. Wayne Swan MP
Treasurer
T:02 6277 7340 F: 02 6273 3420
E: wayne.swan.mp@aph.gov.au

The Hon. Kevin Rudd MP
Prime Minister
T: 02 6277 7700 F: 02 6273 4100
Email: alister.jordan@pm.gov.au
Email ankit.kumar@pm.gov.au

This may be a silly question : :redface: Does anyone have any idea when these changes would take place ? At the end of this year etc ?

I think that Dusty is right - There should be a limit on the amount that these people can charge in the first place - rather than a limit on the amount that patients can get back.

From what I heard this morning there will be a maximum amount that you can get from the safety net for particular services. And it won't be particularly large. But, the actual medicare rebate will go up for the services so the amount that you get back before you hit the threshold will be more and also the amount that you get back if you exhaust your safety net will be more than you would get now if there weren't a safety net. Does that make sense?

It's still awful and will hurt but not nearly as much as if they excluded certain treatments entirely.

But it will effectively limit the number of cycles that people can do a year because while the first few will be covered the ones after that won't be. It's going to be much easier to get into a clinic in the last months of the year than the first.

To answer your question WLAB - no way of knowing. But, it will be one of four - either as of 12 May (budget night), 1 July or 1 January or a random date that they make up but the other three are the most likely possibilities. I hope that it is 1 January because I will have already exceeded pretty much any cap for this year already, and while I could theoretically start another stim cycle before 1 July I won't be finished it.

Arggghhhh!!!!!

Muppity did you get a sense of whether they will also be limiting the number of times you can claim the increased Medicare rebate, as opposed to a limit on the Safety net?

I'm in a taxi bet mtgs. This is all over the news (radio) but focus of news seems to be OB fees.

A double blow for those of us who need ART and who's DH has SHOCKING varicose veins! Wonder why they included that in there?!

Anyway, many thanks to Dusty and Muppity for keeping us all well informed. It will be intereseting to see if the real Budget and the 'leak' are exactly the same...let's hope for the best.

Sorry girls but I am devastated - I know that I will need at least another two cycles to have any chance of ever having a baby, I already had two this year (The Medicare Saefty Net is not for the financial year but for the annual year) and so if this is true I'll probably won't be covered for any more - especially as my clinic is probably one of the most expensive ones in Australia.

Dusty: thanks for the email contacts again I've sent of another email. I didn't get any response to my earlier one. I think they just don't care.

Sara

Lenny, sorry but I don't think there is any more hope in hoping for the best - this decision is 95% made - they usually leak all the bad news before budget night so that only the good news is left.

The worst thing about it is that they have a good chance to get this through the Senate - while the Liberals may not have supported means testing it is pretty close on what Tony Abbott suggested a few years back.

Sara

Sara :hug:. It does suck that we seem to be hit hard with this measure. Together, hopefully we can change things to be a better outcome for those of us that need IVF to have a family.

Reading the news reports this morning, shows that the media are focusing on the fact that there have been increasing rorts of the system by clinicians and clinics. However, there doesn't seem to be any (or limited) focus on the impacts of this on the patients who the Safety Net was originally designed to protect. The conversation is the wrong way around IMO. It seems the media are lapping up the Government's reasoning for making the changes without questioning the impacts of such rorts and hence the impact the Gov'ts move to stop those rorts will have on the those of us that need medical intervention to create Australia's next generation.
It then smacks of "go forth and procreate, but only if you can do it by having a fun time doing the BD and not by expensive invasive medical intervention".
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To answer your question WLAB - no way of knowing. But, it will be one of four - either as of 12 May (budget night), 1 July or 1 January or a random date that they make up but the other three are the most likely possibilities. I hope that it is 1 January because I will have already exceeded pretty much any cap for this year already, and while I could theoretically start another stim cycle before 1 July I won't be finished it.

Arggghhhh!!!!!

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If you pay up front for a cycle before July 1 for example, you would have to get 80% back under the old regime. I just rang the clinic, rumours abound of July 1 or Jan 1. I am now on the phone to medicare, who said "it's speculation" .. This is insane :wall:

WLAB, just rang SIVF - prepaying for cycle is unfortunately not possible, they can only bill from the date you're starting the FSH otherwise Medicare won't accept the claim.

Dusty: Fully agree with you - I am angry that clinics like mine are overcharging and costing Medicare so much money, but it's awfully unfair that we should have to pay for it.

Sara

the changes won't come into effect until Jan 1 next year if they come in - they can't disadvantage people who are currently using the safety net - they have to wait until the year is finished and given the medicare year is jan 1 - dec 31, they have to run with that

it's like the changes to the baby bonus that happened - it came into play from start of new calendar year so that women who were already pregnant (apart from those due in the first fortnight of the new year) wouldn't be disadvantaged at all

Are they over charging us all though Sara? I'm not sure. :dunno: I guess time will tell if the costs come down at all.
FWIW my experience in NZ is that it cost us a lot more per cycle than it cost us here (if you are funding it yourself or you can go on a public funded wait list).

I am not sure Lenny, I am just referring to some extracts of the Age article

"Since the advent of the safety net, fees have leapt by 290% for IVF and 40% for obstetrics - giving rise to claims that the system is being rorted."
(...)
"Between 2003 and 2008, the average fee charged for planning and management of an artifical reproductive treatment cycle increased from $294 to $1148. The average obstetrics fee for planning and management of a pregnancy rose 40 per cent between September 2004 and 2008 - from $1238 to $1732. Specialists' incomes in these areas have soared. In 2008, the highest 10 per cent of IVF specialists were paid $4.5 million each through Medicare - including $2.2 million through the safety net."

You never know how much of this is true and how much is manipulated in a way to influence public opinion.

I remember that the first time I looked into PGD for my condition which was about 2002 I was told I would be bulk billed - my last cycle was charged at about $12,000 plus 8*$76 for Orgalutran. Out-of-pocket was about $4000.

I am aware that my friend in America paid way more than we are here....

Sara

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Muppity did you get a sense of whether they will also be limiting the number of times you can claim the increased Medicare rebate, as opposed to a limit on the Safety net?

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Current feeling seems to be no limiting the number of times you can visit - just limiting the amount that they will pay above and beyond the the scheduled fee.

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You never know how much of this is true and how much is manipulated in a way to influence public opinion.

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Yes, you are so so right.
I noticed that on the 9 news they nicely hid the 'IVF & Obs fee' issue, with a 'oh my goodness, beer and ciggies might be going up'.

Holding my breath and practicing deep breathing at the same time - all will be revealed tomorrow....

Finally found something on this:
IVF funding hit, nurses get more power - this says:

From January 1, 2010, once a patient reaches the safety net threshold of $1,111.60 in out-of-pocket medical fees, or $555.70 for those on low incomes, safety net payments will be capped at:

- $200 for the planning and management of a pregnancy, including being booked into a hospital for delivery

- $30 for a pregnancy consultation, including blood, urine and weight checks

- $550 for the planning and management of an IVF pregnancy

I think this means that once you hit the safety net (i.e., ONE cycle - don't we all hit it after ONE) the most you can get back is what? I can't figure this part out...$550? it's not an ivf pregnancy until the pregnancy happens unless they take the PUPO approach (that is meant to be funny)...and is it $550 per ivf cycle post safety net? This may mean 1 cycle PER YEAR for people - that's horrible. I never thought it could be this bad (I hope I'm reading this wrong). The clinics will be so busy before this kicks in!

Thanks Julie - I have been trying to find something about the MSN after the Budget also. This is just shocking news - I basically read it as once you reach the Safety Net Threshold of the amounts listed, then you will only get $550 back per IVF Cycle. I don't know about this wording of IVF Pregnancy, that's just plain stupid to me. I just don't know how some people are going to afford more than one cycle per year.

I'm having trouble parsing this through as well...

$200 must have something to do with OB fees...but then there's the $30 cap as well which sounds like dr visits during pregnancy (these must be per visit amounts??? or is the $200 a one time amount per pregnancy?)

I think you are right - the $550 must be per cycle post hitting safety net...it can't mean for the remainder of the year? can it? whatever it is, it's cruel.

here's some more...I think the title of this article says it all: Infertile women lose out in budget - budget-09 - LIVENEWS.com.au (there's not much substance to the article)

here's some more...I think the title of this article says it all: Infertile women lose out in budget - budget-09 - LIVENEWS.com.au (there's not much substance to the article)

I know that when I had my DD my OB charged a one off managment and planning fee - so I am guessing that this is what the $200 is for. Then each visit her charge varied between $75 and $150 and was basically a weight and urine analysis session, so all that would be covered now is $30. I was going to say at least I had and still have Private Health Insurance, but that is now going to be means tested under the new Budget.

I also hope that the $550 is per cycle. I am actually sitting here quite gobsmacked as is my DH when I explained it all to him.

I really hope that this gets blocked by Parliament (is this possible?). Yes, we still have private health insurance but without any rebate. I'd be OK foregoing the rebate if the ivf safety net payments remained the same - but how much can you take from 1 couple without giving anything in return?

I laughed when Swan said this budget was about taking care of hard working families. DH & I are very hard working and they certainly did not take care of us.

Godd one Wayne - that means for me instead of $4000 out-of-ocket per cycle now $8000, interesting - Will have to see how many cycle I can do until January 1.

Sorry Girls, but it really makes me angry - $550 is a joke when one cycle costs $12,000 - the only really good thing about it is that it will only come into effect on Jan 1 which is now the deadline for the end of my IVF journey. In theory this can get blocked by parliament but I don't have much hope.

Sara

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Will have to see how many cycle I can do until January 1.

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Whats scary is that this is going to be a large percentage of us in this country... and so now will come the waiting lists, the people opting for what clinics/FS they can afford (if you can say afford at all :rolleyes:) and not their own clinics/FS out of choice....

I appreciate that the FS' and clinics could do their part & drop prices... but honestly, what are the chances of that happening? :rolleyes:

From what I can gather, the 'wording' of $550 to 'plan & manage IVF pregnancies' will include the consults/testing AND the actual cycle - a consult with your FS BEFORE the cycle & to pick up drugs can cost approx $150... so there's a large chunk of it there before you even pay for the actual cycle....

Its a devastating blow.... and much worse than I thought - I honestly was expecting for them to perhaps cap the 80% at 1-2 cycles per year & then drop it to a lesser amount... we're not even getting the opportunity for 1 cycle at an affordable rate :(

Its devastating.... we can only keep writing & then hope that we have the support to try & get it blocked or at least challenged through parliament......

I am wondering if they mean limiting the planning fee for IVF which is one of the IVF line items that has blown out over time. THis may not mean limiting the actual cost of the cycle though.
I don't have any other info at this stage and am hanging on a thin hope.

Media RElease from Health Department
Department of Health &Ageing - A Sustainable Medicare Safety Net=

Its still not clear what the limit is though

KK - well, I don't think anybody should keep paying an FS who's not producing results or listening to their patient. If you scroll back through old threads you'll probably come across some rants from me about men and making babies - like their know our bodies better than we do LOL!!! And now with the Government planning to cap IVF and Obstetrics, we all need to preserve the limited opporutnity we've got.

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...

OP.

It will interesting to see if the rate of back to back cycle's increases by Jan 10. This is very hard on us, imagine the young girls that will need IVF in the future.

If it is $550.00 per cycle, would that mean about 66 % is covered by safety net, per cycle ?

Im lost, are they not paying the medicare component of a cycle either ?

So MIVF charges $4400.00 upfront to me, out of pocket atm is $858.36 (without pgd) and then they charge medicare direct another fee (who knows what that is) are they scrapping that, so we need to pay that, hence Sara's post of her cycle costs doubling ... ?

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: