Medicare Safety Net, EMSN and obstetrics fees ~ I am confused can anyone help?

We are about to hit the Medicare Safety Net, but when it comes to Obstetrics Fees I know they have changed the rules, and there is a constant referral to the EMSN and a benefit cap that it has to be reached before you get more back but I can't find this anywhere and am getting completely confused :lol:

Because I don't know it we will acutally get anymore back on the obstetrics side once we pass the MSN Threshold or not. I am pretty sure that for the "big fee" for us it is ar 24 weeks, we pay $1060.40 and we get back $260.40, leaving up OOP by $800. Which we have to accept as we have chosen to go private, but we will be very close to hitting the MSN prior to that appointment, if we did would it make any difference, or is that the rebate and nothing will change?

I know when I had my girls 2 years ago, that management fee counted towards the MSN. I was just under the MSN prior to paying the fee so a small amount of the fee went towards meeting the safety net and then I got 80% back on the remainder. My total OOP expense for that fee was not much in the end - maybe $200-$300.
But if things have changed since then, I have NO idea and would be interested to hear what you find out!
Sorry can't be of more help.

Can't help either! I am just as confused as it has all changed since last year. Hope someone can help.

I am glad i am not the only one who doesn't understand it :ROFL: If someone had been seen by their OB prior to January 1st are under the "old" system, so get all the extra rebates.

so from what i understand ( which is VERY limited i might add :ROFL:) the max u can claim is around the $500 mark......
and i think thats when u have hit the safety net, BUT if ur management fee goes towards it u might get say $300 ish....

thats if what i indertsand is right, so i prob wouldnt rely on it to much!

I dont even think you can claim up to $500

My ob fees have cost me over $6000 and so far i have got back about $250! eek.

I dont even think you can claim up to $500

My ob fees have cost me over $6000 and so far i have got back about $250! eek.

I saw my ob the first week in Jan, bugger should have gone a week earlier. I have paid the management fee but they said to wait to claim it until next month, so maybe they do combine it? Last time we got half back about $1300, it's a big difference but I love my ob. Will have to check and see how much we have spent this year, I have had extra ultrasounds and dd has had a few appointments so I must be almost there.

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I dont even think you can claim up to $500

My ob fees have cost me over $6000 and so far i have got back about $250! eek.

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:o :o :o :o :o

Woah that is huge!

I have paid out $1320.85, received back $750.85 (that covers OB appointments, scans, bucket loads of blood tests, scans through the High Risk Clinic), so atm $570 OOP. I would be talking to your OB's office because you should have received back more than that :hug:!!

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I saw my ob the first week in Jan, bugger should have gone a week earlier. I have paid the management fee but they said to wait to claim it until next month, so maybe they do combine it? Last time we got half back about $1300, it's a big difference but I love my ob. Will have to check and see how much we have spent this year, I have had extra ultrasounds and dd has had a few appointments so I must be almost there.

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I wonder why they said to wait until next month... it would make it a new financial year, but I thought the Medicare Safety Net ran over the calendar year.....
Oh what a bugger about being a few days out :(

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I dont even think you can claim up to $500

My ob fees have cost me over $6000 and so far i have got back about $250! eek.

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i think the $500 ive herd about is the max if u have reached ur saftey net, or so i was told...

$6000??? is he gold plated?!?! crikey!!! but im all for seeing a OB and if thats what it costs then id be paying it too, thankfully mine is only about $3500 before rebates

Oh wow

i do have a fee sheet from his office with amendments due to the new madicare changes

Fee ////// Medicare pay /////// You pay ////// Total cost to me!

1st appointment $175.00 ///// $68.75 ///////// $ 106.25 ///////// $ 106.25

4 antenatal visits $1537.90 ////// 68.35 ////// 1469.55 ///////////// 5878.20

Mid pg visit $463.4 /////////// 463.40 /////////////// 0 //////////////// 0

all other visits are covered cost free from medicare

Lou's Ob is high risk, they tend to charge more ;) His fees are not a heap more than alot of average Melbourne Obs

hehe Janie, you know we are having the million dollor baby! lol what with all our added IVF cost!

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:o :o :o :o :o

Woah that is huge!

I have paid out $1320.85, received back $750.85 (that covers OB appointments, scans, bucket loads of blood tests, scans through the High Risk Clinic), so atm $570 OOP. I would be talking to your OB's office because you should have received back more than that :hug:!!

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OOps and im not included BT and US!

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Oh wow

i do have a fee sheet from his office with amendments due to the new madicare changes

Fee ////// Medicare pay /////// You pay ////// Total cost to me!

1st appointment $175.00 ///// $68.75 ///////// $ 106.25 ///////// $ 106.25

4 antenatal visits $1537.90 ////// 68.35 ////// 1469.55 ///////////// 5878.20

Mid pg visit $463.4 /////////// 463.40 /////////////// 0 //////////////// 0

all other visits are covered cost free from medicare

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WOAH, how long do the antenatal visits last?

Our Initial Visit was ~ $218.75, get back $68.75 so $150 OOP
Antenatal Visits are ~ $82.90 get back $37.90 so $45 OOP (I've had 7 plus two extra scans through her which were Bulk Billed) Depends on how far I get I am going fortnightly and after 30 weeks weekly.
Management Fee is ~ $1060.40 get back $260.40 so $800 OOP (@ 24 weeks)

My OB is quite cheap in comparrison to others..... My OB is also a High Risk OB and is very highly recommended as one of the top OB is in the state.

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Lou's Ob is high risk, they tend to charge more ;) His fees are not a heap more than alot of average Melbourne Obs

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ok that makes a bit more sense....

we are in melb but my OB is in the suburbs so that prob helps with his costings as well....

our fees are

180 at first appt, we got 60 back
then every appt is $90 with $30 something back till we hit safety net then its $60 something back
at 20weeks we pay $1800 and get some piddly amount back
then at 30weeks $700 nothing back...

plus the monthly scans i have and the extra costs of being addmitted for a stitch and what not....

Mine are similar to crumpets but I fi shared care with my gp so save a little there, I skip half the visits.

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Mine are similar to crumpets but I fi shared care with my gp so save a little there, I skip half the visits.

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can u do that when u go private??
i didint knoe that....

mind u my OB is a bit of a security blanket :redface: so i prob wouldnt but thats handy to know

I trust my gp, he used to deliver babies until the insurance was too high so maybe that's why he can? I love that I can see him if issues come up without forking out more money and he calls my ob if need be.

With dd he convinced my ob to take me off the insulin for my gd as my levels weren't high enough to be on it and I was feeling like crap, I managed fine with my diet after that.

It doesn't make any difference as to whether you had seen your FS previous to Jan 1st or not, unfortunately :(

After asking the girl at medicare when we claimed everything, she explained it to me like this...

By law, you are not allowed to claim back the $$ from medicare for your management fee until 20 weeks - we missed out by a week as I was 20 weeks in the 2nd week of Jan.... grrrr!
(Some OB's have let you pay/claim early, but they can lose the medical licence if caught).

If we had been 20 weeks before the change, we would have gotten back 80% of our OB's management fees (saying we had reached the safetynet, which we had as we had done 2 rounds of IVF within the calendar year).
With the changes now, though - its just a set amount no matter what your OB charges (the governments attempts to make OB's have to be more competitive with their fees)
So no matter if your fees are around the $1500 mark (like Beemas) or the $6000 mark (like Lou), you still only get the same amount back - which is approx $470.

Our OB's management fee was $4500 - and $100 per visit.
We got back $470 from the $4500 (ouch!) and about $80 from the $100.
If baby had been concieved 9 days earlier we would've gotten $3600 back instead of the crummy $470 :wall:
(Although I'm counting my lucky stars, though, as we were lucky enough to get 80% back on the 2 IVF cycles we'd done that year, so you can't have everything I guess ;))

After having bub, we just got the last account from our OB - which was $1300 for the c/s.
I'm yet to claim that back to see what percentage we get from medicare - but I'm not expecting to get much, as I know my OB is pretty exxy compared to most.... bummer, but we wouldn't have gone with anyone else, & for what we've been through to get our little man, any price was worth it for us... like Lou, he's our million dollar baby :rofl:

Hoping all of my natter makes sense ;)

Hollybolly has explained well! Just another thing to remember, keep all your receipts. As with out of pocket expenses you may be able to claim through tax. As in when you hit the $1500 out of pocket threshold (medical) for ATO you can get back 20c in the dollar? after that $1500 threshold. So keep all receipts and remember to request Tax statements from Medicare, your private health fund, Pharmacy (scripts).

HTH

Thankyou everyone for posting and helping to clarify the issue as you can see there were quite a few of us feeling very confused :lol:

If you register online for Medicare you cna also access all your statements there, I will definitely keep the OOP expenses in mind when it comes to tax time as well. I don't know if we have kept al our pharmacy receipts, but gee they add up to a lot with the amount of Meds that DD and DH are on!

Just looking at my little medicare slip I had already reached the saftey net and my 20wk fee was $2526.40 charge / 306.30 (sch fee) / 463.40 benefit 511 code EMSN threshold reached -cap applied to benefit. so it does look like you may get a bit more back after reaching the safety net but not much. I also paid another $1134 which was all OOP.

Hey Beema, go to your Pharmacy or Pharmacies and request a Tax Receipt. They can print off one for you when it comes to scripts as they keep records on their system. Ask for all the family, your DH may have to request his own.

Crikey I am glad I have allready had my boys as those costs are crazy!

I went private with both and go pretty good refunds.

I'm in Melbourne too, Loula, and my OB charges about the same as yours. Total OOP cost just for the OB is slightly more than $6000. As Janie said, that's perhaps slightly more than the Melbourne average... but only slightly!! I did ring around when I discovered that I was pregnant this time and found out how much it would cost us OOP to return to my previous OB. The least expensive OB I called (I only called those whom I had personal recommendations for) was still $3500 OOP.

First appt was... mmm... something around $200 and I got back 60 something bucks. I will pay $3500 at 20 weeks, rebate is about $400, then pay $1500 at 30 weeks no rebate from Medicare. I have been told by my OB's receptionist that Medicare have capped OB rebates and the total I will get back is somewhere between $400 and $500. Is VERY expensive!!! But we have chosen to go back to the same OB who delivered our last two kiddies, so we have no choice but to suck it up... and pay up!!!

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Hey Beema, go to your Pharmacy or Pharmacies and request a Tax Receipt. They can print off one for you when it comes to scripts as they keep records on their system. Ask for all the family, your DH may have to request his own.

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Really! that is brilliant, thankyou so much for that I will definitely be doing it, I go to the same pharmacy every time, DH accassionally goes to a different one, but he knows where to go now :D

I had an OB appointment yesterday and asked there and they had trouble finding the info, but another mum waiting said that she spoke with Medicare and if she passed the Safety Net prior to the large payment of 24 weeks, she was then able to got the standard $260 back, PLUS an extra $200, but if she hadn't passed it priro to that payment she would have received only the $260 back.

We are with $100 of passing it and I have another OB appointment between now and then so we will be close.... might have to see the GP in the meantime..... :think:

Thanks beema, not much back is it. The govt really thought ob's would drop their fees??? I will have to see how close I am, will get the bill to claim next week.

No it isn't and the fact that you have to be past the SN it before you get the extra, it is worth paying for an extra Dr's appointment or so to get the extra $200 back!

I have online registration, it is so good as you can see it really quickly :) I am almost checking daily atm to see how we are tracking :rofl:

There was no way OB's were going to drop their fees, I am just lucky that mine are so cheap in comparrison to others, and that my OB spreads her fees out so that we can get the best value :D

well i went over the SN in March! still doesnt mean i get much back IMO.

just getting DH's appointments done this year now lol, just the skin Dr to go! woohoo lol

I have an online registration have forgotten the password though so I have to get it reset. Arrrgh!

Can ia ask a question relating to the money you can get back in tax when you spend over $1500 - Does my daughter reipts go on my tax return or my husbands?

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well i went over the SN in March! still doesnt mean i get much back IMO.

just getting DH's appointments done this year now lol, just the skin Dr to go! woohoo lol

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When it comes to OB and IVF, nope you get stuff all, very dissappointing how much you have to pay out and get so little back :(

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I have an online registration have forgotten the password though so I have to get it reset. Arrrgh!

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:doh: is there an email option for resetting the password?

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Can ia ask a question relating to the money you can get back in tax when you spend over $1500 - Does my daughter reipts go on my tax return or my husbands?

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I assume if you are all on the same Medicare Card, that it can go to either, who ever needs the better Tax deductions, I would check with your accountant or maybe post the question in the Bills and Financing section :)

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Can ia ask a question relating to the money you can get back in tax when you spend over $1500 - Does my daughter reipts go on my tax return or my husbands?

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I have included dd1s receipts on mine hers alone was $1500+ because of her hips, but it needs to be the out if pocket stuff any rebate from Medicare or phi comes off the total. You can also include dental too. You just work out whoever has the highest income and apply it to that return. In our case it was the same but the bills were in mine and dd's names.

my Ob is seems so cheap compared to others on here

first visit is $160 (medicare rebate $68.75)
all visits after that $85 (medicare rebate $34.40)
if he does a ultrasound it costs $60 (medicare rebate $29.75)
Handling fee $1800 (about $300 8medicare rebate)

i am no where near the SN i went and asked the other week and they said i only have like 300 and something but i think i should have more then that. does it go off the whole visit or just the amount u get back?

Just the amount you get back from Medicare.

*UPDATE*

I paid my management fee yesterday, which was $1060.40, I had just passed the MSN the day before by a whopping $1.80 :lol:
And I got back $463.40 wooo hoooo which was $200 more than if I hadn't already passed the safety net :dance:

My next appointment is in two weeks so I will see what my OOP charges are going to be after that date, but was pretty happy with the saving and it may my Management fee less that $600, not as good before the changes but it has certainly made a difference ;)

wow thats great you seem to have got back more than i had? for the ammount paid! good for you! (remind me its your shout! lol)