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Thread: Medicare safety Net

  1. #1

    Join Date
    May 2006
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    Sydney
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    Default Medicare safety Net

    Hi all,
    I am a little confused about the medicare safety net... Do you have to reach the threshold before doing IVF to be reimbursedthe 80% of out of pocket expenses? Or does the IVF put you over the limit so therefore you can get reimbursed? Hope that doesn;t sound confusing..


  2. #2

    Join Date
    Jan 2005
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    in the valley of cuddles with mountains of smiles
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    Default

    We had some of safety net but our first IVF cycle would have pushed us over the limit anyway... depends on your clinic and how they class the different procedures though - inpatient stays are not covered by safety net at all only outpatient procedures /scans/etc billed as OP.

    So say you already had a few hundred on safety net threshold ... they take the balance off the IVF cycle and apply it ... then you got reinbursed the 80% of the remaining amount. By 1st FET we were over the limit and 80% , 3rd cycle 80%. On first cycle we only were part of the way so we only got 80% on the balance over and above - after we reached the threshold but not the whole amount.Hope that makes sense

    From memory one cycle was enough to put you over the limit anyway - but the thresholds went up in 2006 calendar year to $1000 so I am not sure now.
    Ring medicare and they will tell you were you are up to.

    Goodluck with your cycle - I see you are in Syndey - what clinic are you with if ? only if you want to say

  3. #3

    Join Date
    Dec 2005
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    Bendigo, Vic
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    Default

    Hi Mez
    The threshold is works on your out-of-pocket costs. That's the difference between what medicare gives you back and what you actually pay. So say your GP charges you $80 for a general visit, then you go to Medicare who give you back 85% of the scheduled fee for a visit which is $37.15 so you get back $31.60 from medicare and the remaining $48.40 is your out-of-pocket cost. It's this $48.40 that counts to your threshold.

    The same principle works with something like an IVF cycle - I paid $4711.95 for an IVF cycle. The scheduled fee was $1730.30 - so my out of pocket expense was about $3242 by the time I got 85% of my $1730 back from medicare. This out of pocket is above the threshold of $1000. So then I get 80-% of $2242 (which is $3242 less $1000 of the threshold) back from Medicare once I register for the safety net. Then anything else for the whole calendar year I also get 80% of the total fee I pay back for the year.

    Hope that makes sense?

    Oh and it is only for out-of-hospital costs. So things like anaesthetic fees don't count. You need private health insurance to cover those.

    If you have private health insurance then you have to add back in what you PHI gives you back to what you get back from medicare. So it takes longer to get to the threshold.

  4. #4

    Join Date
    May 2006
    Location
    Sydney
    Posts
    169

    Default Thanks Heaps

    It's making more sense after those posts - thank you all. The nurse told me to wait until after my procedure before i claim with medicare. Im not to sure why that is as the hospital time is not covered. I will take her word for it, since we have 55 days before we start to pay off the credit card anyway.
    I am going through Next Generation Fertility and seeing Dr Knight. Have been happy with them and the prices are pretty good for a private clinic.
    Having my 2nd blood test tommorow, then if all is well...i start injecting..:eek:

  5. #5

    Join Date
    May 2006
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    Sydney
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    Default

    Baby Amore - Goodluck with the Twins... its just around the corner, how exciting

  6. #6

    Join Date
    Dec 2005
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    Bendigo, Vic
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    Good luck Mez

    The reason they make you wait is that things can change as you go through the cycle. For example cycles can get cancelled because of something unexpected. In that case the clinics usually only charge you a smaller fee. Or you may find that semen analysis shows a really poor sample meaning that you have to suddenly have ICSI - which increases the costs. That happened to us.

    My clinic only makes me pay the expected out-of-pocket bit up front and they leave the medicare claimable part for afterwards. They send me the bill and ask me to send it on to Medicare. Then medicare sends my specialist the cheque directly. That's ok except that it REALLY slows the whole process for getting to the safety net and getting reimbursed because it takes weeks and weeks for medicare to send the cheque out to the specialist and the specialist to send you the receipt so you can go into Medicare to claim the difference on the safety net.

    I learnt that one the hard way. On my second go I paid the second bill on my visa, got a receipt instantly and then rocked into Medicare to claim all of it back AND get my safety net for the first part of my treatment. It all happened in 7 days instead of 7 weeks. The guy at medicare said not to tell anyone! SO I AM.

  7. #7

    Join Date
    Mar 2006
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    soon to be somewhere exotic
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    Default

    Our clinic advised us to go and register for the safety net before we came to see them the first time (seems only single people get it automatically - couples/families have to go and register). We had already gone and seen the doctor.

    We pay the "out of pocket" expenses on day 4 of our first cycle (approx $3K). Then at the end of the first cycle they give us the bill with all the amounts included (about $11K), this is what is used for medicare & mbf and the rebates go directly to the clinic.

    Not too sure how this is now going to work for us, as we're only going as far as harvesting, we're not going to implant for a couple of years.

  8. #8

    Default

    I have paid $4500 for my OB. I understand that if I reach the Medicare Safety Net threshold of $1111.60, I am eligible to claim 80% of the fees. Currently, the receipts that I presented i.e. my out of pocket expenses that I have paid so far is $555.

    My question is :

    Since I have paid $4500, would this amount add into the $1111.60 threshold and I would be eligible to claim 80% of some of the $4500

    OR

    Does this $4500 not add into the $1111.60 threshold as currently I only have $555 out of pocket expenses and I can't claim the 80%. If this is the case, how much can I claim?

    Would greatly appreciate for some help in this query

  9. #9

    Join Date
    Feb 2009
    Location
    Brisbane
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    Default

    Ok, so I think it works like this:

    You paid $4500. In order to reach the safety net you have to pay $1110.60. So you take that off the $4500 which leaves $3389.40 - that is the amount that will get the 80% back on.

    Now that you have reached the limit for this this year, should you do another cycle that costs $4500, you will be able to claim back the 80% on the whole amount, the $4500.

    When the new medicare year starts again (01/01/10) you have to reach the threashold again.

    Hope that all makes sense

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