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Thread: IVF and private health cover

  1. #1

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    Default IVF and private health cover

    Hi ladies,

    In the new year we are facing the possibility of undergoing IVF. I just called my private health cover (MBF) and they have told me that they don't cover anything as it is classed as an outpatient proceedure. Does this sound right to you? Does anybody have private health that covers IVF? Sometimes I wonder what I am paying these people for

    He said that Medicare could cover some of it and I have called them and they have told me that they do cover some of it but it is such an involved claim that she couldn't give me an estimate. Is this where you claim back from?

    Sorry to ask a dumb questions but I have no idea with all of this IVF stuff.

    TIA


  2. #2

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    My IVF wasnt covered by my PHI except the in hospital procedures such as the pick up and theatre and anaestists costs
    With IVF all the out of cycling is charged under medicare and once you reach your medicare threshold you are eligable to rebate 80% of the billing charges not the scheduled fee. I think in 19 cycles I claimed one cause it was too much hassel to try and recover $40 lol
    Bec

  3. #3

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    Kt, we don't have health insurance (well my DH does, but I don't), but from what I've read, a lot of them don't cover most of the IVF costs anyway.

    You should get back a fair bit from medicare though, so that's helpful.

    It's a lot of money, I know. I'm pretty stressed about it myself at the moment. Couldn't have come at a worse time for us actually, with xmas and all!

  4. #4

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    kt - I've been doing a fair bit of research on this too. We're with Medibank Private and from memory they do offer some assistance with ART after a waiting period of 6 months. To what degree I'm not sure. My gf did say she didn't bother mucking around with private claims because Medicare take care of you.

    Like what Willow and Bec have mentioned, you do get a decent rebate from Medicare.

    Maybe you can ask your clinic if they have some paperwork which might give you a bit of an idea. I have all the guff MIVF gave me and it is helpful to see deposit req'd and out of pocket in black and white. One bonus is at least we are getting in nice and early in the year that way we'll get maximum bang for our buck over the threshold!

    I read on the handouts they gave me, we wouldn't need to pay the total say $3800 and then claim back, we would be asked to pay the out of pocket difference upfront etc

    When you are certain that you are going ahead with the IVF you do have a couple of appts, one with a councellor and in MIVF case, accounts appt and one with the nurses all on same day. I'm sure that at some stage you could discuss the financial side with them. Not everyone has thousands of $ just laying around waiting for something to spend it on (and quickly!)

    It wouldn't hurt to give them a call

  5. #5

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    I was covered with MBP but they only rebate on what is done as a patient admitted to a hospital which in the big picture wasnt all that much
    Bec

  6. #6

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    Thanks for your replies ladies. I was at the shops today and had to go into Medicare to claim for all of the other scans and my last AIH cycle and the girl there gave me a bit of info about how much they will cover so I am not feeling too bad about it now. And Smudge as you said once you reach the safety net they cover a higher % for the rest of the year. She said that to reach it you would have to have $1000 out of pocket expenses and I suppose with IVF you would reach that pretty quickly.

    Thanks again.

  7. #7

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    Hi Kate,
    We have been doing IVF for four years now, and knowing it was always going to be our only option, I spent months researching every private health fund before we made a decision.
    The fund that covers more than anyone else is Manchester Unity.
    We have been with them from 12 months before we started IVF in 2003.
    For example, our last cycle cost us;
    $3200 up front fee with IVF Australia.
    $0.00 Hospital - Fully covered by health fund.
    We got $2300 back, so out of pocket was approx $900.
    Out of this $900, most of that is from having our embryos grown to blastocyst - this is $650 and not claimable by anyone.(Medicare or private health).
    We got our statement from our health fund a few weeks back and it showed that the hospital fees were approx $1500 - our fund covered 100%.
    Without the health cover, our total out of pocket expense would have been $2400 instead of $900.
    (We did get the 80% rebate from medicare, because it was our 2nd cycle for the year, which is why the gap was so small. Manchester Unity still covered the hospital 100% the first cycle of the year as well.)
    I also have acupuncture done, and this costs me $40 per session... Manchester Unity pay us $20 back for every $40 spent on this, so we've saved a LOT of money in this area, too.
    I also went to Weight Watchers for 8 weeks to lose the weight I'd put on from the previous cycle before starting this cycle - this cost me approx $170, and I got $130 back from health cover...
    I think if you are aware of what you can claim, it is most definately beneficial.
    If you look on their website, their top cover (healthmate executive) has a special IVF section... this is the cover we have.
    Its $168 month for us - there's 3 of us, but thats absolute top cover for all 3 of us.... it certainly worked out much better than any of the other funds... and I'm constantly checking them to see if anyone else is offerring anything better!!!
    Sorry for my massive post, but hope it helps you out!!!!!!!!!!!

  8. #8

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    I don't have health cover and paid $2400 to IVF (this is the out of pocket amount) and because a reached the safety net, got $1600 of this back. However, I did have to pay the hospital expenses which were $650 for EPU and $200 for transfer. So, all up it cost be about $1600. I know health funds will usually cover the hospital expenses and sometimes a small part of the IVF expenses depending on the cover you have.

  9. #9

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    Thanks Holly and Megan. Holly don't apologize for the huge post that was fantastic information. Once I have finished wrapping all of the Christmas pressies I might spend some time to have a look at your health fund on the net and compare it to our current cover.

    Megan that is good that even without PHI you still only had out of pocket expenses of around $1600. That is what we were kind of expecting to pay per cycle and then I got a bit freaked out when our PHI said they didn't cover anything. But it all seems ok now I have all of this information. I was worried that we were going to be something like $5000 out of pocket and that would mean that we would only be able to do 1 cycle until we saved some more money.

    Thanks again.

  10. #10

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    ktgirl
    I have PHI but only for obstetrics/gynaecology not ART. I found it made about $85 difference to what I paid if I'd had ART cover per go but the increase in premium to get that coverage was not worth getting higher coverage. Most IVF clinics do most things as outpatients so that you can claim them on medicare and once you reach the safetynet - which you do with the first IVF treatement - then you get more back from medicare. All up for 2 stim cycles and 1 FET I paid out about $15k for absolutely everything (including non-claimables like accupuncture and naturopathy - I don't bother with ancillary cover) and I ended up $5k out of pocket. So it is still not a cheap exercise. There is a thread somewhere in LTAC about costs. I think Keen started it ages and ages ago. It should be a sticky.

    If you are planning a family and you want PHI - there is usually a 12 month waiting period.

    Good luck with your journey.

  11. #11

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    our clinic gave us a list of what was and wasn't covered under private health care & what would be out of pocket (approx $3k including sperm aspiration for DH), we were also told to register for the safety net before starting IVF as we would hit the safety net really fast. We also have to pay all out of pocket in one hit on day 4 of my cycle when I go in for the 2nd lot of drugs.

    Talk to your clinic - they should have a good idea about which private health insurers cover what. Remember that you will have a 12 month wait as I think using IVF is classified as "pre existing".

  12. #12

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    To add to all the great info everyone else had already provided - two things to keep in mind is just how differently each clinic charges and also what procedures you will be having. Many clinics charge considerably extra for things like ICSI, Blast growth, Freezing 'extra' embies, GIFT, assisted hatching; PGD, etc. Also keep in mind some of these are not covered by the Medicare Safety net either....

    BUT, having said that we still plan on going a few more times yet and the cost is one of the least deterants... however, it is not easy on the lifestyle, thats for sure.

    Hope that helps a little.

  13. #13

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    Hi,

    I paid $2800 for IVF and got $2000 back from medicare because I'd gone over the $1000 threhold. PLUS I paid $1300 for the egg pick up because I wasn't in a PHF. So that is where the big cost lies because you don't get much back.

    My RE was going to get me a discount with the anaethitist next time so you should enquire about that as it's obviously the done thing.

  14. #14

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    Medibank Private do rebate some portions of IVF (egg pick-up, theatre and anaesthetist costs) ... but there is a 12-month wait if you've only just joined, and by the looks of it, the premiums are a lot higher than Manchester Unity - DH and I pay about $330/month (before the 30% tax rebate).

    We did reach the Medicare Safety Net threshhold very quickly though .. and it really, really helped the financial side of things.

  15. #15

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    wow, this thread really got me thinking. i decided to a bit of research myself today - have had PHI for quite a while, and i couldn't remember exactly what was covered (my fund combind with another and we kept all the old benefits under a new name - unfortunately, that means that it's not available to just take a look at on the net!) - made a call today and first three cycles of IVF are covered - which is awesome (and hopefully enough)! and we're lucky - paying less than $200 per month! yay!!

  16. #16

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    Hi, briggsy's girl. I did exactly the same as you did. After reading through all these posts, decided to check my PHI cover. I am with MBF and they don't seem to cover a whole lot. What is the name of the fund you are in? I know you said your funds are combined but I thought I would give it a try. First three cycles of IVF covered sounds really good.

    Thanks

  17. #17

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    hi Lisa C
    i'm wih Latrobe Health Insurance. they started as just a couple of small local PHI's but are now larger in VIC - they have a website or i can give you number if you want to PM later

  18. #18

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    Thanks briggsy's girl. I will be sure to look them up. Have a great new year.

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