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Thread: Capping Medicare Saftey Net for IVF/ART

  1. #217

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    13209 is the same item number for IVF - planning and management

    It all makes sense now : I quickly looked online at my medicare history

    $2875 - management fee last year -

    $3400 - management fee Jan 09 - Government paid $1844.20 before s/net
    $3400 - management fee April 09 - Govt paid $2733.00 after s/net

    $4400 - management fee May 09 - gove to pay $3520



    The clinics keep upping there management fee's = and they have caught on .... So it's $550.00 per management fee .......

    The govt will still cover the other medicare things

    He said more than once we will be no worse off - I dont see how, that's why he suggested shopping around ..

  2. #218

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    Crikey WLAB! What clinic are you with?

    So glad we are flooding their phone lines. But what do they expect with so little information being available.
    Last edited by dusty; May 13th, 2009 at 12:04 PM.

  3. #219

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    Hi, I don't think that is true - the budget papers say it's all IVF item numbers:

    Medicare Benefits Schedule — capping Extended Medicare Safety Net benefits for items with excessive fees

    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 to all assisted reproductive technology items and items for treatment of varicose veins, the injection of a therapeutic substance into the eye, hair transplants and a cataract surgery item. The caps will take effect from 1 January 2010.

    In 2008, expenditure on the Extended Medicare Safety Net was $414.1 million, an increase of 29.7 per cent from the previous year. The items to be capped accounted for around 28 per cent of all expenditure on the Extended Medicare Safety Net in 2008 and the expenditure on these items has grown at an average rate of approximately 50 per cent per year for the past two years.

    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 Extended Medicare Safety Net was introduced in the 2003‑04 Budget.

    This measure will provide savings of $257.9 million over four years.

    Medicare Benefits Schedule — capping Extended Medicare Safety Net benefits for items with excessive fees — obstetrics services

    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.

  4. #220

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    Hmmm, I just found an old receipt from March 2007
    13209 = $4,200!!! Sch fee = 75.60 Benefit = $2,645 (after safety net)
    So regardless of whether it's just this fee or all of them, it's really going to make a huge difference. If the Sch fee remained unchanged and safety net extra capped at $550, then we'd have had to pay a LOT more

  5. #221

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    He did say there would be caps accross the board - say each "straight forward" cycle, claims 5-6 item numbers, the most the clinic charge for is the # 13209 - they will be meeting with clinics to drop the price on that, and, that is where some clinics will reduce, I presume, and some wont ....

    If the clinics want "business", they will have to re-structure their pricing

  6. #222

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    I think the cap is on all items numbers, like Sara quoted... whichever way you look at, we are going to be A LOT WORSE off, its as BAD as it can get...

  7. #223

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    Yeah, if they cut their management fees by, say, two-thirds, then it might end up roughly the same as now....
    Having said that, I think we'll just have to wait and see exactly how this pans out - sounds like nothing has been finalised just yet.

  8. #224

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    i guess these huge fees are the reason they're suggesting "shopping around" to see what you can get. i know in Melbourne there are two major clinics being Monash and MIVF - but there are also smaller clinics - perhaps if we start going to the smaller clinics with more reasonable fees, it might make the larger clinics rethink their profiteering on that particular code kwim?

  9. #225

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    BG ; I would be intersted in knowing the smaller clinics name's.. I am all for, shopping around ...

  10. #226

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    i go through Gippsland assisted conception that feeds into both melbourne assisted conception and monash depending on the treatment (we're regional) - from what i can gather, if you're in Melb, MACC is in heidelberg and last i looked, their IVF costs were a lot less than Monash...

  11. #227

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    Just cheked on the report on which all this is based on, you can find it at

    http://www.health.gov.au/internet/ministers/publishing.nsf/Content/12D0DDC7B95C7568CA2575B4001349FC/$File/nr059.pdf

    Basically 50% of all the Safety net payments are for obstetrics and IVF.

    Maybe we should be writing to Julia Gillard, see below an article from a few days ago, I was actually crying when reading this.

    IVF a future investment
    Sunday Herald Sun
    Robyn Riley

    May 10, 2009 12:00am
    HOW cruelly ironic to know this Mother's Day that there are women out there quietly aching in the despair that they may never get the chance to be a mother themselves.

    And all because some politicians have decided their need is not as important as others. That's the way I am reading the Budget leaks regarding tipped changes to Medicare caps on IVF treatments.

    The safety net now reimburses 80 per cent of out-of-pocket expenses after those using infertility treatments have reached a set and reasonable threshold. It is what makes IVF accessible and affordable for all.

    If the speculation of cuts to IVF funding is true, such treatments will be out of the financial reach of many Australian couples from next week. Having a baby could become a luxury.

    I'm appalled a Labor government would let that happen - making money a deciding factor in who has children. Infertility is not nature's way of eliminating unworthy parents. Nor should it eliminate those with limited incomes. If this is indeed the intention of the Budget, then the Opposition should attack the Rudd government for an act of betrayal.

    It was on the eve of Peter Costello's Budget of 2005 that the then shadow Health Minister Julia Gillard became the champion of the infertile community. Loud and determined, she launched a public petition in protest against a plan to limit access to public-funded IVF - and the public outrage forced Costello to shelve the idea. Ms Gillard was a hero. The next year, with Treasurer Wayne Swan, she again petitioned for taxpayer support for IVF. If the cuts are introduced, it is a disgraceful about-face.

    On the ABC, Mr Swan refused to comment on reports of cuts to IVF funding and the private health rebate. He said there were hard choices, "especially to make room for a commitment to pensioners and it is absolutely vital that we put in place nation-building investments to stimulate the economy and to invest in the future". Here is the thing: there is no better investment in our future than children. They are our future. It's not too late, Mr Swan. Change that Budget now.

  12. #228

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    That's a great article Sara and good suggestion to write to Julia Gillard....I hope she didn't completely forget her proposition now Govt is in power...will write sth tonight....

  13. #229

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    Yep, we'll definitely be shopping around next time. Wanted to change clinics in any case.
    Thanks for the article Sara

  14. #230

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    Our clinic (repromed in Adelaide) is ridiculously expensive for the planning and management fee

    I just checked the Planning and Management fee 13209 - ours was $4850 of which the Medicare safety net allowed us a rebate of $3371 - so if this is now only $550 - its still $4300 out of pocket for this item number - I wonder if our IVF clinic will alter their fee structure? Far out - DH and I were just talking about it and might just hope for a miracle conception with the next one ..........

  15. #231

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    I have been following this thread for a while and am quite worried about whether DH and I will ever get the chance to become parents

    I have written a couple of letters already and will put my pen back in motion this weekend.

    We live in rural NSW and unless we want to travel a minimum of 5 hours, we only have the choice of one IVF provider. So the advice of "shopping around" is not an option for us!!!

    We are due to start our first IVF cycle shortly and I am just that it's successful. If not, we may just have to surfice with our furbabies

  16. #232

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    I dont understand how the government can do this. Do they think we are all made of money? Because we are infertile does it mean we shouldnt have access to treatment? IVF is always more money, more money. Now this. I think its a huge injustice. I am lucky enough to have my little bubbas but i feel angry, sad and disappointed for all the people out there who may not be able to afford it in the future (including us).
    I will speak out and support any of you girls or any plan of action that anyone thinks we should take. It really is a horrible upsetting day

  17. #233

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    I spent 30 minutes or so on the phone with a Michael Ryan (I think I have the spelling right). I was trying to take notes in a taxi while heading to...my IVF clinic!so I hope I got what he said...

    What they believe is that 1 - IF you attend a clinic that is at or below the average price of ivf clinics and 2 - IF that clinic agrees to revamp the way they charge items (what the above posts are about - the item numbers and what we are charged for such will become very, very important - especially how much they charge for the management fee aspect which is where there is a huge discrepancy between the $550 and the charge), then with respect to a "typical" IVF cycle, you should be no worse off under the new program. The government believes that a lot of the money is going to the clinic and is not reflective of the costs associated with the medical aspect of IVF, and that in order for patients to receive maximum benefit the clinci will have to restructure the items to more closely align the costs to the various phases of treatment.

    As for the average price - they are using somewhere around the $6-7,000 mark and said if you are currently falling within this range, you are getting back about $5000 now and would continue to get back around $5000 under the changed program assuming the clinic changes its fee schedule. If you are paying more than the average, you definitely will be getting back less - he said this in black & white terms.

    He did admit that it is more likely that those IFs would become reality for those of us who are in bigger cities with multiple clinics as if one changes, it will drive them all to head towards the change - otherwise patients will leave and go to the clinics where they will receive more back from medicare. He also said that it is possible that they might start reimbursing more for things like ICSI and PGD under the new program assuming everything goes through the proper government approval channels on the medical side.

    I also asked about IVF drugs - he said that no one had asked this yet and he was pretty sure that there'd be no changes there although he was going to check with the pharma benefits dept (I did not ask him to call me back to confirm - I just have too much going on right now).

    So, that's my understanding - I may be a bit off because I was distracted by my taxi driver who almost had 3 accidents! ...

  18. #234

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    ps - if this becomes a done deal in this way - we will have to direct our efforts at the clinics - I don't know how effective that will be unless they really do see a significant drop in patients

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