Capping Medicare Saftey Net for IVF/ART

tk1999 and any other non LT members or those LT members with family and friends who have always wanted to help but didn't know how, you can always ring, write or email your local Federal member and the Health Minister Nicola Roxon and express your concern that any changes to Medicare and the Safety Net should not limit sub/infertile Australian's access to assisted reproductive treatments.

I think if there is noise and expressed concern from the general community it can only help our case to get the best possible outcome.

Thank you for wanting to help :hug:

Your MP's contact details can be found HERE

Nicola Roxon's office
Minister for Health and Ageing.

PO Box 6022
House of Representatives
Parliament House
Canberra ACT 2600

Tel: (02) 6277 7220
Fax: (02) 6273 4146

Email: Nicola.Roxon.MP@aph.gov.au

Electorate Office Contact
Maribyrnong Office:
1 Thomas Holmes Street
Maribyrnong Vic 3032

Tel: (03) 9317 7077
Fax: (03) 9317 7477

Dusty - love the link in your ticker!!

Dusty, Buliej and others...thanks for the information and for chasing this up. DH and I are away this week and have been worrying about this, but you have clarified some aspects. Sounds like clinics have been putting through some big amounts! DH and I arent in a position to shop around, being in a regional area.

Julie,
You are correct - this is exactly what the government is trying to do:

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It does seem that patients have been put in the middle of a battle between the government and the clinics.

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I read in a newspaper article a while ago, that they were hoping that OBs and IVF clinics would reduce their fees because patients would not be able to afford the increased fees. I believe that some OBs and many IVF clinics did take advantage of the safety net to increase their prices. Even to the point where IVF clinics (in victoria) saw it as an opportunity to privatise. that is completely unethical as it is taxpayers money they are getting and I believe that the government should crack down on it, because it is taxpayers money. But it is completely unfair that the patients have to do the government's "dirty work" so to speak and be forced to try to influence IVF clinic policys on pricing.
Personally I believe that those people rorting the system should be "named and shamed" so they can be boycotted. It is probably a few people who have ruined it for everyone else. I think everyone should be contacting personally and via mail, the CEO of their IVF clinic. I think as most are run as businesses now, they probably have a business manager and CEO and ask what they are going to do about their prices.
I am really sad for anyone experiencing infertility. I know how awful it is and when I was paying for IVF prices were nowhere near they are now.

Thank you for the information Dusty - I will start on the letters tomorrow night and send them off.

Happy to make as much noise as I can. Will also rally my family and friends to get them vocal

I am too tired to really understand it all. From what I have read here (sorry, I really just skimmed tonight) my one and only frosty will be our last attempt. We just won't be able to afford another stim cycle.

Fortunately we have the miracle of our DD but we dearly want another baby. I just feel so let down and can't imagine how it must feel for those less fortunate than me. Those who are only finding out now that they need AC must be devestated. Imagine trying to get into a clinic and getting started before Jan1???

Mr Rudd is a Dud as far as I'm concerned. WTH did he give millions of dollars away to every bloody Tom, **** and Harry and then have to scrimp and cut costs everywhere? Why the bloody hell didnt he just save that money and spend it where it is needed?????!!!!! Aaarrrgh soooo angry!

Thanks so much to those of you who have gathered all this information. I promise to read more thoroughly in the next few days... once the anger has subsided a little. I just feel so sad right now.

Thanks girls for starting this thread and giving me a run-down of what's going on. It is totally unfair. Even if this is to get at the clinics who are charging too much, we will be the ones to suffer. I'm glad I'm booked in already for this year. But I really feel for those who will be needing to start next year and beyond.

This is ridiculous, I can't believe they have done this. The media referred to ALL ART item numbers, which is scary.

Just looking at my last bill, my planning and management fee was only $220 for item no 13209 (for a frozen cycle) however no 13200 was $5850 which I am praying they dont cap.

Apparently my article will be in the West Australia tomorrow about the cap to IVF funding.

Ok, girl looks I am with one of the clinics which are rorting the system:

--- 13200 is a whopping $9,550 - Medicare refund is $1778.95.
--- 13209 is $205.00 with a Medicare refund of $67.
--- 13251 (PICSI = ICSI) costs $340 and is fullly fedunded by Medicare with $337.75
--- 13212, 13221, 13215, drugs supplement, theatre fees for EPU and ET= 13212, 13215
= total is $12,730 (Medicare refund of $2556.45) >>> $10.173.55 before the Safety Net

-- On top of the bill comes $720.00 for Orgalutran and $340.00 for the anesthesist plus lots of money for all my and DP's supplements and Acupunture ($65 per session)
-- then deduct about $1500.00 refund from my healthfund for EPU and ET.


From memory I got about $8600 from Medicare, so the Safety Net paid about $6000 in total.

This is SIVF, Sydney for a PICSI (different form of ICSI) PGD Cycle billed in Jan 2009 - maybe we could collect some more cycle costs here in the thread?

The problem is that to my knowledge my clinic has the best results in Sydney -- they are also the best ones for my specific form of PGD and probably the only ones which do PICSI -- so shopping around is not an option for me. I am happy to go to Aldi to buy homebrand baked beans but we're talking my and DP's dream of having a family here!

Sara

Sara - hopefully the competition in Syd will force them to change. I suspect that the clinics (at least where there is competition) will change some but proably not enough to put us back on equal footing.
I def think that as "consumers" we should push for completely transparent and comparable success rates if we are going to pay a higher portion of the clinic's non-medical fees.

A big thank you to those who are trying to make this all clearer for the rest of us.

I think we really need to apply some pressure on the government. It's not over, they haven't et in stone what the amounts are going to be, so we need to get involved.
The article from today can be found HERE

I found this article when I was surfing yesterday:

More choice for mums-to-be but a penalty on IVF | The Daily Telegraph

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The Government reform to the Medicare safety net, capping benefits to those patients who access IVF and also obstetric services.

From July 2010, a patient whose doctor or IVF provider charges more than $5000 per cycle will not receive the rebate, which covers 80 per cent of out-of-pocket expenses.

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I also saw a lot of the articles you've already got posted...

Wow, I can't believe how much some clinics charge. Do you pay $4-5000 to the clinic AND then the clinic also bulkbills the same again to Medicare? Did I read that right? :o

I go to QFG in Brisbane and we pay $6300 upfront, then the anaesthetist and my Dr's fees after (another $500-ish). We pay upfront then take the receipts to Medicare, the clinic doesn't bill anything to Medicare directly.

Just claimed my March cycle and it was:
13209 162.20 (planning/management - my Dr's fee - 143.20 rebate with safety net)
13200 6,263.85 (ART/IVF - 4,477.60 rebate with partial safety net)
13221H 36.15 (semen prep - 36.15 rebate)

Now to start again... Third time lucky right? :pray:

Could we set up threads for each major centre where people could post costs for particular clinics as an easy reference? I know there's a thread for cost of IVF but they're all just jumbled in together

Thanks again to the ladies keeping us up to date - really appreciate it

I went for my orientation at IVFAustralia today. I asked about the changes and she was pretty sure some changes will take effect from end of June, even though I pointed out that the media is reporting it to be Jan next year. Very scary!
I paid $4450 for cycle plus $120 for Synarel (hos & athes charges seperate)

BecD - thanks for posting the article!

thanks for all the info
I'm new to this - first appt next week and now really worried
starting to think it's not worth bothering as we just can't afford this.

i'll keep writing emails to ministers and hoping they see sense.

Hi Sandy, IVFAustralia is wrong, it definitely only starts 1 Jan 2010, please see the media release below:

2 May 2009

The Rudd Government will support the long term sustainability of the extended Medicare safety net (EMSN) by making sure public money is spent on reducing costs for patients, not on providing excessive windfalls for medical specialists.

This measure is an important part of the Rudd Government’s commitment to reform and modernise the health and hospital system and to ensure that Australians’ hard-earned tax dollars are used efficiently to provide better health outcomes.

The EMSN will continue for all Australians and for all services currently covered. The safety net thresholds have not been changed from $555.70 for Commonwealth concession cardholders and recipients and $1111.60 for all others and are indexed each year by the Consumer Price Index (CPI).

However, there is evidence that the EMSN has enabled some specialists to charge excessive fees – resulting in excessive windfalls being paid by taxpayers through Medicare.

The Government will take action to ensure EMSN funding is used to benefit patients and reduce their costs.

In this Budget, the Government will change the EMSN to provide a maximum safety net benefit, or ‘cap’, for a small number of MBS services where there is evidence that the EMSN is being used to excessively increase the income of specialists, rather than reduce costs for patients.

These changes will apply to obstetrics, assisted reproductive technology (ART), cataract operations, the injection of a therapeutic substance into an eye, hair transplants for alopecia, and varicose vein treatment. In all these areas, some specialists are charging excessive fees, however very little of the taxpayer funding of these procedures is helping patients.

For each item that is capped, the Government will only provide safety net benefits up to a maximum amount. Patients who are charged reasonable fees will continue to be supported by Medicare and the EMSN, but specialists will no longer be able to increase their fees excessively, assuming that taxpayers will pick up most of the cost.

This measure starts on 1 January 2010.

This initiative responds to an independent review of the EMSN which found:

* doctors have increased their fees as a direct result of the EMSN, resulting in increased costs for some services where families have not qualified for the EMSN; and
* for every dollar spent on the EMSN in 2007, as much as 78 cents was spent on meeting providers’ higher fees rather than reducing patients’ out-of-pocket costs.

These excessive fees have resulted in taxpayers funding million dollar incomes for some specialists:

* the top earning 10 per cent of obstetricians were each paid an average of $1.1 million a year per specialist through Medicare, including $612,000 through the EMSN; and
* the top earning 10 per cent of ART specialists were each paid an average of $4.5 million a year per specialist through Medicare, including $2.2 million through the EMSN.

For all inquiries please contact the Minister's office – 02 6277 7220

Changes may put pressure on IVF doctors
in case anyone is interested (also see last sentence about restructure of system)

Hi Everyone,

I have just read all of your posts and have just emailed my local government again regarding the susbidies and levies. These are the people I sent my requests to (per below)

I have basically asked if these cuts can be reviewed and would like somone or maybe more to be a voice for all us IVF patients. I have told them that I have not started yet as we have been saving for our upfront fee & paying for private health insurance (we are a normal hard working couple whom are no means RICH).

I hope that I get some sort of reply or recognition, I did receive a few responses when I emailed them a couple of months ago when this was a so called rumor.

Please be aware that the list below is my local members in Victoria which are Frankston, Mornington, Cranbourne, Dandenong and have also emailed a couple of other well known MP's even Julia Gillard. So I hope those of you that live near me can also email them like I have.

wayne.swan.mp@aph.gov.au
alister.jordan@pm.gov.au
ankit.kumar@pm.gov.au
alistair.harkness@parliament.vic.gov.au
jude.perera@parliament.vic.gov.au
john.pandazopoulos@parliament.vic.gov.au
david.morris@parliament.vic.gov.au
john.brumby@parliament.vic.gov.au
Julia.Gillard.MP@aph.gov.au

All we can do now is hope and pray that this works for us all. :pray:

I just got a reply from one local member, he must be working late. See below. Great to get a response now I will email Mark Dreyfus.

Hi Tammy and i thank you for your email.

I have read your email with interest.

As your matter is related to the Federal Tier of Government, i suggest that you also take the opportunity in contacting your local Federal Member of Parliament for the Skye area, Mr Mark Dreyfus MP.

Mr Dreyfus' details are as follows:

Mr Mark Dreyfus QC, MP
Parliament House Contact
PO Box 6022
House of Representatives
Parliament House
Canberra ACT 2600

Tel: (02) 6277 4305
Fax: (02) 6277 8484

Electorate Office Contact

Keysborough Office:
Location/Postal Address:
Shop No.6, Parkmore Shopping Centre
Cheltenham Road
Keysborough Vic 3173

Tel: (03) 9769 1955
Fax: (03) 9769 1977

Once again i thank you for your email.

Regards
Jude Perera MP
Chair
Family and Community Development Committee
State Member for Cranbourne District
157A Sladen St, Cranbourne
Tel: 5996 2901,
Fax: 5996 7494

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These excessive fees have resulted in taxpayers funding million dollar incomes for some specialists:

* the top earning 10 per cent of obstetricians were each paid an average of $1.1 million a year per specialist through Medicare, including $612,000 through the EMSN; and
* the top earning 10 per cent of ART specialists were each paid an average of $4.5 million a year per specialist through Medicare, including $2.2 million through the EMSN.

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This is the part that bothers me so much - they keep quoting this stat to get people to agree that it's ridiculous, and yes absolutely some clinics charge a fortune!
But the cost of my clinic covers 24 hour phone coverage when I have questions, and around 20 staff including embryologists, nurses, reception and accounts staff etc. It's not like my specialist is getting the $8k straight to them for each cycle!

Absolutely, let's look at ways to get these prices under control, but punishing the patients is not the way to do. What clinic in their right mind is about to drop their fees by thousands of dollars?! And will our chances at IVF suffer because of this? Will my clinic not use embryo glue because its just that tiny added expense that they dont want anymore. Or go back to 3 day transfers, because its cheaper than going to blastocyst.

I think they have just opened a huge can of worms.

Bec- I couldn't have said it better myself ;)

If you're going to start writing letters at this stage, the best people to be petitioning now are the senators. The budget has to get through the senate before it can become reality.

Bec: Absolutely agree, it bothers me too it, sounds like my FS earns 4.5 million but in actual fact she is running a business and while she may earn a pretty good salary the money covers the nurses, scientists, facilities, blood test, ultrasound and medications.

For contact details of senators by State/Territory, go to http://www.aph.gov.au/Senate/senator...asp?sort=state

Sara

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If you're going to start writing letters at this stage, the best people to be petitioning now are the senators.

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Done.

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Done.

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Ditto!

Infertility is never a choice - we the intending parents, should not be penalised or discriminated against on this issue.

There is now some more information from the Health Department at the MBS ONline portal.

See here for direct link to the changes to teh Extended Medicare Safety Net MBS Online - Changes to the Extended Medicare Safety Net

Thanks Dusty, it is definitely not as bad as I thought, I think for me it means around $2500 extra out-of-pocket - coudl be less or more depending on how my clinic will adapt its billing process.

Hopefully for patients at clinics which charge less it won't make a big difference. I wonder whether there are other item numbers in IVF that we could insert such as BT and ultrasounds. It would be worthwhile to pressure the clinics to take the BT out of ART services and to bulk bill for them.

Sara

Thanks for posting that link Dusty.

Isn't totally bad - I will do some maths later.

the bit that I like is that that is the refund every time you do it - rather than a once off which is what was originally feared.

Comparing apples with apples:

With MIVF the current OOP after safety net is $858.36 for a standard IVF cycle
Under the new scheme the OOP for the same cycle will be $2494.

That's a rough calculation using the item numbers from the last cycle and assuming you have reached the safety net and that MIVF structure their item fees to get maximum cap per item..... There is still a big difference in my opinion from the current system to this new one...thats an extra $1600 per cycle or in real terms two extra cycles a year under the current system....grrrr!!!

Eeek! Finally worked out the maths...

Current system - $916
After changes - $3284

:wall:

And then add the cost of the drugs and hospital, anesthetist, cryogenic's and so on...

*deep sigh*

I finally got around to looking at that link, thanks Dusty.

Last bill for Frozen Embryo Transfer (after we passed safety net)
13209 - Paid $220, Benefit $191.85, OOP $28.15
13218 - Paid $2035, Benefit $1786.30, OOP $248.70
= $276.85 for FET

With new cap (once passed safetynet cap)
13209 Same - OOP $28.15
13218 - Paid $2035, Benefit $1138.50, OOP $896.50
= $924.65 for FET

= $647.80 increase in FET cost

I got out a couple of my old receipts and latest price lists from some of the Perth clinics. The figures are really scary. Nobody is going to be better off from this.

FSWA - June 2008 (Prices went up 10% in Dec 08) for IVF w/o transfer
13200 - Paid $5850, Benefit $5040.05, OOP $809.95
13209 - Paid $200, Benefit $75.45, OOP $24.55
13221 - Paid $120, Benefit $105.45, OOP $14.55
13251 - Paid $1150, Benefit $997.70, OOP $152.30
13212 - Paid $543.50, Benefit $500.60, OOP $42.90
= $1044.25 + non medicare items (theatre, day bed, anaethetist etc)

With new cap (once passed safetynet cap)
13200 - Paid $5850, Benefit $3067.05, OOP $2782.95
13209 - Paid $200, Benefit $75.45, OOP $24.55 (SAME)
13221 - Paid $120, Benefit $73.20 OOP $46.80
13251 - Paid $1150, Benefit $452.30, OOP $697.70
13212 - Paid $543.50, Benefit $413.45, OOP $130.05
= $3682.05 + non medicare items as above

= $2,637.80 increase in IVF

I got charged this today..

13209 (Planning and management of an ART cycle) $4900 - got back $3993.45 OOP = $906.55

are some practices charging everything under 13209? - because the scheduled fee according the medicare for this item is only $79!

It doesn't look a lot better when they charge it all to 13200. I have $6263.85 charged to 13200 and the benefit (85%) is $1,778.95. The proposed safety net cap is then $1,220.00, leaving an OOP balance of $3264.90. Compared to our current OOP of just over $900.

Does anyone understand the difference between the 75% and 85% medicare benefits? I can't find anything explaining it on the website.

Hi Juniper

I found this on the medicare website. Not sure if it is what you are looking for.

Benefits for private in-hospital services Medicare - the basics (Mediguide: section 1) - Medicare Australia

Cheers
Jo

I can understand where medicare and the government are coming from - it seems like some Practices are wroughting the fees.

I am assuming under the new schedule in January it will force Practices to re-evaluate their fees and make them list items individually?

I thought today on my bill I would see more than 2 item numbers for IVF and ICSI ... but all I had was 13209 & 13251... what about the rest, why weren't they on my bill???

13200 ART services
13203 Ovulation monitoring services
13206 ART services
13209 Planning and management of an ART cycle
13212 Oocyte retrieval
13215 Transfer of embryos
13218 Preparation and transfer of frozen or donated embryos
13221 Preparation of semen for ART or artificial insemination
13251 Intracytoplasmic sperm injection for ART treatment

Thanks Jo.

Krikkit, the bill from my clinic only has items 13200 and 13221. My Dr bills 13209 separately (currently about $160).