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Thread: Capping Medicare Saftey Net for IVF/ART

  1. #271

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    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!!!

  2. #272

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    Eeek! Finally worked out the maths...

    Current system - $916
    After changes - $3284

    Last edited by juniper76; May 21st, 2009 at 01:25 PM. Reason: edited numbers to include both items 13200 & 13209

  3. #273

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

    *deep sigh*

  4. #274

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    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

  5. #275

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    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
    Last edited by ~BecD~; May 31st, 2009 at 02:50 PM.

  6. #276

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    Default Is this right?

    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!

  7. #277

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    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.

  8. #278

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    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

  9. #279

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    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

  10. #280

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    Thanks Jo.

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

  11. #281

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    People - we are just scarring ourselves.

    There is no point looking at what is currently being charged in certain line items and then extrapolating the figures to say what we are going to be charged in the future.

    Kristy has the right idea.

    At the moment most line items aren't really being used because it is just easier for the clinic to whack it all onto the management fees and it makes no real difference to us because under the safety net we still get about the same amount back.

    What the government is trying to do is make the clinics better reflect what services are actually provided.

    Hands up who has had an ultrasound? or seen a Nurse? Anyone ever seen one on their bill? I know that I haven't. So by making the clinics better account for the actual services that they provide it will add a lot of transparency to the process and people will be better able to compare clinics and work out which ones are rorting the system.

    What most clinics will do is [hopefully] change their billing practices so that patients can claim the maximum that they can from Medicare and in doing so show medicare exactly what services are being used.

    I am not saying that people aren't going to be worse off - I for one know that I will be because my clinic is one of those who have really nigh fees and I can't imagine that that is going to change.

    But what we have to remember is that the changes won't yet be reflected in your bills by way of line items because there is not yet a need to do so and behind the scenes the clinics will be working to produce the best outcomes for their patients. In the end we have to remember that they are effectively a business and need to be doing the right thing or they won't have nearly as many customers and a business without customers wont' make any money no matter how much they charge.

  12. #282

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    Great point Muppity.

    Like Krikkit my clinic moved last year to charging the whole amount onto the one line item (management) 13209 which worked in my benefit as it was all under my name even though my sister was my ED and she had the majority of the treatment for me. Hence it went towards my Medicare Safety Net (MSN) rather than Em's.

    As I pay for the whole cycle this worked out well for us as she was only having any treatment for my benefit. Potentially under the new system, the costs now will be split between Em and I (depending on who has treatment for what) and I will be paying for the two of us to reach the MSN separately IYKWIM. Which will increase my costs significantly {sigh} and take a lot longer to reach.

  13. #283

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    well we finally received a letter from the clinic. apparantly our case had been put forward as an example of a couple who had a couple of frosties, but due to the hike in prices come Jan '10 want to do a full IVF cycle now.

    We were OOP roughly $2000 for one cycle of IVF with ICSI (roughly $4000 has been handed over so far, and we have 2 frosties) Obviously the plan was to not put myself through another full cycle but our hands have been forced.

    The letter from the clinic advised clients to consider making hay while the sun shines this year....because as of Jan IVF with ICSI OOP expenses will go up by $4600

    so that'll be $6600 roughly per cycle. Does not help with the bitterness already felt re. having to pay in the first place.

    Feeling so low right now.

  14. #284

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    If you want to read what was said in the House - see here - starts on page 7 - ***warning - this is a link to a large PDF document***
    http://www.aph.gov.au/Hansard/reps/dailys/dr150609.pdf

  15. #285

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    Thanks Julie
    I have just read the couple's story read by Mr Dutton and was in tears. I then moved to the MP Mr Cook's speech about his wife and his experience with IVF and burst into tears. I will have to come back to it later to finish reading the debate.

  16. #286

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    I know - each story is so touching and personal - I haven't been able to finish reading it either.

    I think it's great they read them into the record (and obviously took the time to read some of the letters).

    Personally, I like that Dutton called Gillard out on her statement from 3 years ago which was "It is a cruel thing to do to Australian women particularly older Australian women, whose only hope of falling pregnant is through the IVF process." When they only focus on young women, I feel that people like me get lost or are thought of not worthy of IVF assistance.

  17. #287

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    It gives me hope when the Parliament can hear real people's stories with all their uncomfortable, sad and happy parts. It makes the impacts of what changes they are making more real.
    I too found that interesting as to what Julia and the labor party said a few years ago when the Howard Govt were looking to make changes to IVF. Sadly ironic.

  18. #288

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    I have renamed and made this a sticky thread for easier reference.

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