management fee/medicare safety net

Hi everyone

I am going to be 17.5 weeks on 31st Dec. Is it going to be possible to claim back from medicare the 20 week management fee from medicare before the safety net changes. My saftey net is already up to $700 so we will get a fair bit of it back if we pay it prior to dec 31. I have asked 4 different people at medicare and noone can give me a straight answer and they have all said something different. One even said it is still in front of the senate and they can't comment.

As this is our first baby we are not sure how this fee structure works and if there is some kind of proof you take with you to medicare to prove you are further along than 20 weeks.

Sorry if this is a stupid question but we are very confused and medicare don't seem to know

will your ob let you pay the fee early?
A friend of mine is in a similar situation, and the ob says they cant make out the receipt until you are 20 weeks, so she will have to claim it in the new year

I asked my Ob about early payment too, so I could make the most of safety net / rebate before the changes too and was told that I couldn't make payment until my 20 week appointment at the earliest and I had to make payment at an actual appointment not just walk in and pay - I scrape in by about 10 days. Will be double checking next week when I go for next appointment.

Unfortunately, according to my specialist, you do need to show proof (from your OB or Dr) of your due date.... :(

We worked out that I will miss out on the benefit by 7 days :doh:
My specialist said there's really no way you can get past it - if he was to say my due date was a week earlier he can be liable for breaking the law :(
We can pay it earlier but medicare won't allow you to be reimbursed until you're 20 weeks +

Ironic thing for us is that I will be having an elective c/s (due to compications & my uterus' damage from past surgeries & issues)... and I'll be having the c/s 7-14 days earlier tham my due date :wall:

Aaah, such is life :rolleyes:

Thanks guys, it's good to know of others in the same situation.

Thats what i thought. Luckily my OB is not super expensive. If only I had concieved the month before... lol!!! My DH is a bit of a tight arse but is very supportive of us going private so he understands our OOP maybe a around $2000 just would have been nice to avoid it for the sake of 2 weeks.. grrrr

I will have a chat with the receptionist and see what she says

Wow your OB is cheap!

Our fee is going to be $4300 :o

Our OB is our fertility specialist though, & he's the one that go us our pregnancy after 6 IVF cycles, so we wanted to stay with him ;)

yeah i am grateful for the fact he is cheaper than most otherwise we would have had no choice but to go public.
Hollybolly - you must be on cloud nine. congrats on your bubs after 6 ivf cycles this little peanut was destined to be yours.

I asked my ob about it too and they said they couldn't give the invoice until you are 20 weeks. Luckily I scraped in in the last week of December, and luckily they are going to let me see the locum Ob while mine is on holidays!! I see him on the 30th Dec.... just by the skin of my teeth! What a PITA it is!

i spoke to my OB about this yesterday......
i will be 20 weeks on the 7th of jan.....

they said as long as im going in for a appt before the 1st of jan they can invoice me and i can pay before the 1st of jan.....
so im going in to see him for my 20 week appt at 19 weeks and then i can claim it....or so he tells me!!

if i cant claim it ill be out of pocket $3000 ish...

Mrs Hendo - Thanks ;) Its still sinking in, but it feels amazing! Have to keep pinching myself to make sure I'm not waking up from a dream anytime soon :lol:

Crumpet... ooh, thats interesting! My specialist said not to lose hope yet as they may change the way they itemise/ charge it to help with OOP costs.... I can't believe how close we all are!!!
They should have a period of time afterwards (but I guess whos to say what period of time - there'll always be someone who will ''just'' miss out I guess :rolleyes:)

oh I won't complain about my Ob fees - were $125 first appointment, $1850 OOP at my 20 week appointment and rest of appointments are bulk billed :) I've got some kind of bonus system on my private health and as I haven't used hospital at all have no excess to pay when I go in.

I rang medicare yesterday to find out where I was with the safety net and I have only used about $400 so far, which leaves me about another $600 till I reach it (think it's $1100 as I don't have health care card). My 19 week scan will also go towards this before I make payment.

I asked her how it works if my OOP is $1850 and I reach threshold but of course she couldn't give me a straight answer except that she thinks I should get a slightly higher rebate :rolleyes: guesss I have to wait and see.

I think that private OBs are going to have to change the way they charge us to suit the new system.

I was trying to figure out the changes and reading the government health website. It said that OBs have been taking advantage of the safety net and they are trying to stop that. So basically, once we reach the safety net limit (and the management fee well and truly guarantees that) OBs are charging more because it doesn't come out of patients' pockets so we don't complain.

So I'm hoping that we don't all end up worse off in the future, but I suppose it will take some time for things to get sorted out. Not great for all the women who just miss out on claiming this year :doh:

It's funny how narrow minded the governments accounting system can be hey..... I personally don't think most obs are over charging..some are (some suoper exxy city obs are rorting and ruining it for eveyone else) but we forget the extra expenses that obs have abive and beyond normal medicos. for example for an OB to gain public liability insurance is in the vicinity of $90,000 a year and thats after the govt subsidy. Also the average one would be paying for reception staff in the vicinity of $100,000 a year all up when you account for super and workcare levies etc. Say one patient pays $5000 for her pregnancy, thats like 40 women a year they have to see for free before they start to even look at pulling a wage for themselves. Yes they are making money but I dont think they (or most of them anyways) are rorting anything like the govt is claiming.....JMHO....

My fee is $4k, and of that there is a approx $1333 fee that is not claimable. So I know that bit upfront, and the rest is up to where I am with the safetynet... And TBH I agree with Mels points, and besides, I like my OB, and that money that I pay him is asking him to drop everything and be at my side when I need him.

I was in the same position as you all in my last pregnancy, and when I made my claim early in the year, it put my over the safety net, and that then made all my further medical expenses for the majority of the year rebateable at the 80%... So it worked out OK. And also, remember you can clam an additional tax rebate on medical expenses so you do get a bit more back at tax time...

:clap: Mel - Completely agree with your whole post!

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And TBH I agree with Mels points, and besides, I like my OB, and that money that I pay him is asking him to drop everything and be at my side when I need him.

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Exactly how I feel, too Ruf ;)

There's no way I would change as my OB is my FS as well... he got me here & so knows exactly what I need & how to go about it to get me the rest of the way!

He did say that they would wait for confirmation from the government towards the end of the year, but were looking at charging differently to make it better for patients etc - I think in terms of item numbers etc.

We have passed the safety net this year well & truly with 2 full stim cycles of IVF at a little over $6000 each time - but I'm so glad we got a pregnancy this year, so I'm happy enough that our cycle worked while we were still able to claim the IVF through the safety net! The OB fee would have been an extra bonus, but at this point, I'm so damn happy I have a positive result, I'm happy with anything now :lol:

Hey does anyone know if this is definitely going ahead? I heard that it still had to pass the senate but can't find any info

I miss out by a few weeks, am guttered!!! My ob fee is $4000, but he is brilliant and have no choice as the hopsital I want to give birth will only use their obs.

I do think Obs have been overcharing, they earn over a million per year from medicare alone so medicare are just trying to get them to reduce the prices. They have gone up considerably since the safety net was still introduced but I wish it could be delayed a bit longer!

It has passed the senate with a few modifications to the IVF section but the general ostetrics is basically the same as the original outline unfortunately....you can read the new limits here:

MBS Online - Changes to the Extended Medicare Safety Net in the 2009-10 Budget

Hope that helps.

thanks Mel! yeah I rang medicare last week and they said it was still being passed in the senate.... obviously she had no idea!

Hi ladies,

Just an update. I had my last app with my OB yesteday for 2009 and he let me pay the management fee then. I went into medicare and claimed it straight away and they put it in my bank account no worries no questions. The receipt I claimed with nowhere said I was 20 weeks preg.

My OB was $2000 and I got $1396 back from medicare so very happy with that. Otherwise the lady at medicare said the scheduled fee is only $122 and that is all I would have got back if I didn't have the safety net.

Thanks for your update Mrs Hendo. Have been reading this thread with interest as I paid our management fee yesterday - $1850. Medicare gave us back just over $700. How does that work as I thought once you reach the safety net you get back 80% of oop expenses and by our calculations we've definitely reached the safety net? Am I right or is that baby brain? And will private health cover any of the rest of the expense, does anyone know?

Your OOP won't be covered by your private health... Well most won't I work for medibank and I know we definately won't.

The safety net is $1100 ish.. We had already reached $890 ourselves prior to paying the management fee which is why we have gotten more back. As the scheduled fee is only $122 you got back an extra $500-$600.

Prior to doing your tax next year make sure you get an annual statement of benefits from medicare and your private health fund as any OOP over $1500 for the financial year you will get back 20%

Private health cover doesn't cover anything that is not in a hospital, so none of the general ob fees before the birth are covered.

The medicare safety net only includes your out of pocket expenses, so maybe you are over estimating by including the total of the bills from the ob so far?
I found that it was the management fee that put me past the safety net limit so we only got the 80% back for about half of the management fee that was past the limit. I hope that made sense. ;)

Mrs Hendo - you are so lucky, I talked to my Ob about it and he basically said I should speak to his assistant. I did that and she said she'd talk to him, but then at my next appt she just said that because I won't be 20 weeks it's a no go. I am trying to be brave about it and just think in my head that "it's only money" but am still annoyed at the system. Jut one of those things really, no point being annoyed.

Thanks Mrs Hendo. Yeah, I knew about the 20% on our tax, so I will definitely remember to do that.

And Berrme, I think you might be right that I was including total bills and not just oop expenses. And also my fs expenses, some of which weren't covered by Medicare at all.

Thanks for your help. ;)

Update from me on this, got home last night to a nice cheque in the mail from Medicare. I paid my Ob fees in December which were $1864.00 and I got back $1105.00.

Was quite happy with that, since I was originally told I would be $1700+ OOP for the management fee since $122 was the scheduled fee.

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Hi ladies,

Just an update. I had my last app with my OB yesteday for 2009 and he let me pay the management fee then. I went into medicare and claimed it straight away and they put it in my bank account no worries no questions. The receipt I claimed with nowhere said I was 20 weeks preg.

My OB was $2000 and I got $1396 back from medicare so very happy with that. Otherwise the lady at medicare said the scheduled fee is only $122 and that is all I would have got back if I didn't have the safety net.

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That's really interesting Mrs Hendo, because I asked my OB if I could pay my 20 week fee early to claim the 80% back and he said no because I wasn't at 20 weeks by 31DEC. I noticed you weren't at 20 weeks either, so how did you claim this money back from Medicare? didn't your OB have to state you were at 20 weeks or over by 31st December 09?

Thanks!

I have heard most OB won't do it as they are worried about getting into trouble. Medicare just go off the the item no on the receipt. on it states nowhere that I was 20 weeks along. When i went into medicare i was only 15.5 weeks along and noone asked me how far along i was either.

hi all,

i too was concerned about the fees and i was able to pay my management fee which was 5k in December when i was 16 weeks, claimed the money not a problem at all like MrsHendo said no where does it say how far along you are or anything like that they don't check anything.

I guess we're just lucky my OB allowed this and im glad he did as he was bloody expensive!

But a friend of mine asked to do the same and her OB said no in case they check and he gets into trouble, so i suppose it very much depends on your OB