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Thread: Capping Medicare Saftey Net for IVF/ART

  1. #235

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    Anyone know when the proposed changes begin? Is it July or January??


  2. #236

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    Jan 1

  3. #237

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    Julie, I spoke to the same man and got essentially the same info.

    So, it is likely that clinics will have to change their billing systems and charge for each item like (as a minimum they may also detail every stage of a cycle)
    • Initial consultation
    • Cycle Management
    • EPU
    • ET
    • Sperm preparation
    • Embryo preparation etc

    with a set Medicare rebate, plus a capped Safety Net rebate for each item.
    He also said it would be based on the current 'median' prices for cycles. Also the Medicare rebate for items may go up for some items and the cap reflect a smaller difference in cost.

    After reading what WLAB said they are charging for IVF management at her clinic I can understand they want to rope in the rorting under the item 'management'!

    So my understanding is it isn't as bad as first thought. But there is the issue as pointed out above that competition may be easier in citys but not so easy when there is no competition in regional centres.

    The $550 number being used is only in the media is just representative of what they may cap the Safety Net for management for example.

    Importantly I asked what sort of consultation is going to happen with this. It seems they will be talking with the clinics to come up with agreed caps. When I asked about what sort of consultation they will be doing with IVF/AC patients he didn't know and I don't think they have thought about us. He said they will be keeping ACCESS in the loop but they wont necessarily be part of the negotiations. On chatting to him about the fact that patients may have different concerns or desired outcomes than the clinics and that we should be consulted, he indicated that what they may do is put out some Terms of Reference in a few weeks for what they are going to with the consultations and that patients would be able to make submissions - ie you can tell your story and how things will affect you (eg if you are in a regional area and can't shop around for best price) and what you would want to see with any changes - to the Department directly through this email

    [email protected]

    And that more information on the changes they are going to be seeking to make will be available in a few days on the web link Julie provided MBS Online

    I was impressed that he rang me back, was open to suggestions and understood that IVF patients have concerns as to what the changes mean to them. He also was respectful of the fact that IVF patients already have emotional and physical challenges dealing with infertility and TTC and that this should be recognised in the consultations they undertake.
    Last edited by dusty; May 13th, 2009 at 04:44 PM.

  4. #238

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    It does seem that patients have been put in the middle of a battle between the government and the clinics. I never quite paid attention to the breakdown of the fee and the management fee seems excessive. I think they could just call a large portion of it "investor profits"! I have a slightly different understanding of this now - although I am still so angry that we, the patient, will most likely pay the price for any delay or inaction by the clinics.

    Dusty - I had the same experience. He was quite pleasant and patient with me - I couldn't believe he didn't rush me off the phone. I wish they were looking for patients to volunteer to consult on this - just to give us a small voice in this whole thing. I expressed exactly the same concern - that this is a hard journey to begin with without the financial worries and that the goal of ensuring the best and most successful outcome for the patient would somehow get lost in this and he explained that care of the patient is at the forefront of the government's mind. That's all good to say - but again, the means may not result in that goal.

    I have read criticism (can't remember the source - which is kind of important) of ACCESS - that in some ways they are much more a voice for the clinics (as opposed to the patients) thus I wouldn't be entirely comfortable in having them be the only "patient" representative as it may well be that patient's interests do not end up aligned with the clinics.

  5. #239

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    Thank you Dusty - that makes things much clearer.

    Sara

  6. #240

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    Quote Originally Posted by buliej View Post
    I have read criticism (can't remember the source - which is kind of important) of ACCESS - that in some ways they are much more a voice for the clinics (as opposed to the patients) thus I wouldn't be entirely comfortable in having them be the only "patient" representative as it may well be that patient's interests do not end up aligned with the clinics.
    I think you are right Julie, and I expressed this on the phone to Michael. I know my FS is on the ACCESS Board.

    If we keep asking for patients affected to be consulted I am pretty sure they will consult with us. We just need to provide them with an easy way to do it. I plan to keep hassling them and follow up on his offer.

    Now that there is a decision but the details are not set yet, we have an opportunity to be proactive and influence the outcome - at least I really hope so

  7. #241

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    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


    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: [email protected]

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

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

  8. #242

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    Dusty - love the link in your ticker!!

  9. #243

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    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.

  10. #244

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    Julie,
    You are correct - this is exactly what the government is trying to do:
    It does seem that patients have been put in the middle of a battle between the government and the clinics.
    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.

  11. #245

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    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

  12. #246

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    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.

  13. #247
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    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.

  14. #248

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    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.

  15. #249

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    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

  16. #250

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    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.

  17. #251

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

  18. #252

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    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
    Last edited by dusty; May 14th, 2009 at 06:28 PM. Reason: Sorry Bec, we dont allow images to be posted in the threads but I have linked to your blog.

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