Jump to content

Ultrasound criteria


  • Please log in to reply
20 replies to this topic

#1 bluecupcakes

Posted 08 February 2013 - 01:05 PM

I'm just over 12 weeks pregnant and I went to the doctor yesterday to get a referral to book into hospital.  While I was there she gave me a blood test form and also an ultrasound one.  I questioned the ultrasound one as I have never had an ultrasound this early before, she said yes I had to have it but was unclear why.
I called today to book in and the lady asked why I was having it and I just said because my doctor has told me to.  She said unless I meet a certain criteria I will have to pay full cost as Medicare don't cover ultrasounds if you just want to look at your baby.  I asked what he criteria was and she said it was very extensive but you were only eligible if you were at high risk of problems or have had previous pregnancy losses among other things.
So I'm thinking I won't be eligible meaning it will cost around $200 for nothing really.  This was a unplanned pregnancy so not budgeted for, with my other children's starting school and kinder expenses just been paid I can't really afford extra expenses at the moment.
So my question is does anyone know what the criteria is and what you need to do to meet it?  I have looked at the Medicare site but to no answers there!

#2 Beltie

Posted 08 February 2013 - 01:11 PM

I think this is current:


For a patient to be eligible for a Medicare rebate they must fit one of the following criteria and the applicable condition must be present and stated on the request form.

The patient is 12-16 weeks of gestation and referred by a medical practitioner, and
One or more of the following conditions are present...
Hyperemesis
Risk of foetal abnormality
Previous post dates delivery
Abdominal wall scarring
Inflammatory bowel disease
Advanced maternal age
Toxaemia of pregnancy
Significant maternal obesity
Previous caesarean section
Suspicion of ectopic pregnancy
Diminished symptoms of pregnancy
Previous pelvis or spinal trauma or disease
Pregnancy after assisted reproduction
Suspected or known uterine disease
Suspected or known cervical incompetence
Diabetes mellitus
Hypertension
Autoimmune disease
Alloimmunisation
Maternal infection
Bowel stoma
Drug dependency
Thrombophilla
Abdominal pain or mass
Liver or renal disease
Poor obstetric history
Risk of miscarriage
High risk pregnancy
Uncertain dates
Cardiac disease

#3 bluecupcakes

Posted 08 February 2013 - 01:29 PM

Thanks, I actually do fit several of those criteria but don't know what the doctor has put on the form as I can't understand it!


#4 Grant Me Wings

Posted 08 February 2013 - 01:51 PM

I am pretty sure most places charge a gap for the 12 week scan, so try and confirm what the out of pocket will be.

I think from memory the rebate is something like $60-80 and there is sometimes costs for the blood test as well.

#5 Walkers

Posted 08 February 2013 - 02:00 PM

I had the scan last week - cost $200 & got $59 back

#6 Tesseract

Posted 08 February 2013 - 02:07 PM

The 12 week scan is usually for Down Syndrome screening, isn't it? The doctor should have explained things better.

#7 Justaduck

Posted 08 February 2013 - 02:08 PM

Wow didn't realise so many things covered it. I've had a c-sec with DD so would fit those, but she was high risk for DS (but chromosomally normal) so hopefully that is enough to cover it.

I paid $199 and got nothing back

#8 TotesFeral

Posted 08 February 2013 - 02:16 PM

Is the doctor getting you to do the Downs Syndrome screening ultrasound or just a standard one?
With DD I had one at 7 weeks, 12 weeks and then 19 weeks.
With DS I had one at 7 weeks, declined the 12 week one as didn't want it done and then 19 weeks. But for everyone I know it is standard for the doctor to refer them to have the 12 week scan done

It cost me $120 with DD and I got about half of that back off medicare.

#9 bluecupcakes

Posted 08 February 2013 - 02:35 PM

Well under the clinical details part of the form it has,

G4 P3
2MP 12 nov 2012
POG  12 week (there is a symbol between POG and 12 but I can't do it on here)

Anyone have any idea what that means...

I'm happy to pay a Medicare gap of course just not happy to pay $200 for something if its really not necessary.  I don't think I will get into see a doctor before my appointment so really don't know what to do!


#10 purple_daisy

Posted 08 February 2013 - 02:52 PM

I think that means

Gestation #4, Pregnancy #3 (I think that means one previous loss?)
I think it might have meant to say LMP as in your last period was on 12 Nov 2012.

Not sure about the POG. Mine said something like P US 12 week meaning pelvic ultrasound 12 weeks.

My GP said the 12 week is now almost considered routine because they check lots of things like your risks for down sydrome and the other trisonomy conditions and can just check the baby is forming properly, location of placenta etc. We were charged about 200 but got 65 back from medicare. I fit several of those points above but unless your doc specifies it on the form I think most ultrasound places go ahead and charge the full rate.

We wouldn't have done anything even if we came back with high chances of down syndrome or the other conditions but we did it because we would at least want plenty of time to prepare ourselves if that had happened, and it was very comforting seeing that the heart, umbilical cord, placenta etc were all performing well and the baby was measuring correctly.

#11 epl0822

Posted 08 February 2013 - 03:03 PM

My GP referred me for so many ultrasound scans, I thought I was supposed to get one if I sneezed. I wasn't aware there were specific criteria.

#12 elizabethany

Posted 08 February 2013 - 03:08 PM

My GP just wrot 12 week OB scan, and medicare covered it.  I fit about 6 of those criterea, but none of them were on the refferal.

#13 bluecupcakes

Posted 08 February 2013 - 03:12 PM

Your right Purple_Daisy I have been googling and that is what G4P3 means however now I'm even more confused because it is my 4th pregnancy but I have never had a loss so not sure what she is on about there.

From what I can find I think the POG means a dating scan I don't know why she is sending me for that as I know exactly when my LMP was as I allways write it on the calendar!  

I think I might go see another doctor this one is really confusing me!

I never knew there was a criteria for ultrasounds until today either, but like I said have never had an early one before.  My 20 week ones were arranged and done at the hospital it is public and didn't cost me a cent.

Edited by bluecupcakes, 08 February 2013 - 03:14 PM.


#14 Fossy

Posted 08 February 2013 - 03:26 PM

G4P3 is gravida 4 para 3, meaning this is your 4th pregnancy, resulting in 3 live births, your current pregnancy hasn't been born so isn't counted yet.



#15 Beltie

Posted 08 February 2013 - 04:20 PM

The criterion I cut-and-pasted above are for Medicare rebates. They are the conditions for which the government agrees to subsidise an ultrasound around 12 weeks. The individual ultrasound companies can decide how much they charge for the scan so you may end up paying a gap.

This list is not the list of people who SHOULD have the scan. That decision, particularly for the 12ish week scan, is usually made after discussion with your O+G/GP/antenatal team and depends on many individual factors and preferences.

OP, could you leave a message for the referring GP to give you a call to explain why this scan is being requested?

#16 againagain

Posted 08 February 2013 - 07:54 PM

The problem is that you have a referral to the wrong place I think. You seem to have a referral to a private place that will charge you a gap unless you have a health-care card or similar. You need a referral to a public clinic. This is what happens near me anyway, I could be wrong!

Around here if you don't want to pay anything you need to book well in advance and have the ultrasounds done at the hospital clinic. If we go to MIA or the likes you need to pay an amount and then get a rebate from Medicare.

#17 Love_Evie

Posted 08 February 2013 - 08:04 PM

12 week US are standard arnt they? It's not just to look at the baby it's to check the development of the baby.
I had one done previously at a public hospital and it was free. I have also had them done at private clinics which was approx $220 out of pocket and $85 back from Medicare.
Are you delivering at a public hospital? If so they should refer you to their own radiology department and it shouldn't cost you.
Not sure on your circumstances but this was a major teaching hospital in Melbourne, not sure on rural or other states.
Problem is with public is that you need to book really far in advance and often can't choose your date/time. If you ring them and plead your case they might be able to do something though.


#18 Soontobegran

Posted 08 February 2013 - 09:23 PM

QUOTE (bluecupcakes @ 08/02/2013, 04:12 PM) <{POST_SNAPBACK}>
Your right Purple_Daisy I have been googling and that is what G4P3 means however now I'm even more confused because it is my 4th pregnancy but I have never had a loss so not sure what she is on about there.

From what I can find I think the POG means a dating scan I don't know why she is sending me for that as I know exactly when my LMP was as I allways write it on the calendar!  

I think I might go see another doctor this one is really confusing me!

I never knew there was a criteria for ultrasounds until today either, but like I said have never had an early one before.  My 20 week ones were arranged and done at the hospital it is public and didn't cost me a cent.


As Fossey has said G4 P3 is correct for 4 pregnacies and 3 live babies so far.
POG is 'proof of gestation' and is useful sometimes for those who do not ovulate regularly on or about the 14th day  and the 2MP would be doctor's scibble for LNMP:)

You do not have to have this U/S some people choose no to, it is the morph scan at around 20 weeks that is definitely recommended these days.
I do know that all my daughters have been out of pocket around $200 for the NT scan at 12 weeks.

#19 bluecupcakes

Posted 08 February 2013 - 09:56 PM

Thanks for all the replies.  In my past 3 pregnancys I have been offered an early ultrasound I have just chose to not have them.  This gp just seemed to be really pushing it.  She was not my normal gp so I think I will just have my bloods done then try to get in to see my usual doctor.

I will be going to Box Hill hospital, with my others I had my 20 week ultrasounds there.  I only went to the doctor to get a referral to the hospital but she wouldn't give it to me she said I have to get the other stuff done first.

#20 Wildence

Posted 08 February 2013 - 11:47 PM

OP, how old are you? some GPs recommend to do 12 week scan if you are over 35 due to higher DS risk.

I believe 12 week scans are important. as for the POG, that's probably just to confirm the due date.

#21 bluecupcakes

Posted 08 February 2013 - 11:56 PM

Im 34. I have regular 28 day cycles and even know the day I would have conceived so not much need for a dating scan.




1 user(s) are reading this topic

0 members, 1 guests, 0 anonymous users

 

Wondersuit heaven: Bonds & Disney launch exclusive collection

Bonds and Disney fans with babies to buy for will be celebrating this news. Bonds and Disney have just released collaboration Wondersuits.

Perth hospital mistakes cancerous tumour for "behavioural issues"

When Naomi Holly, a mother of three, noticed her eight-month-old daughter Nora, was having difficulty crawling and standing up as normal, she knew there was something wrong.

Piano playing dad soothes son to sleep in moments

There's nothing more frustrating, or distressing to a parent than a sick child who can't  - or won't got to sleep. 

Lucky escape for mum and bub after snake found in couch

Perth mother Laurie Rushton Dyble was sitting on a recliner chair in her home holding her six-month-old son when her husband suddenly told her to get up and leave the room.

When your partner misses the birth

While no one wants their partner to miss their baby’s birth, it can happen. Here’s what to do if you find yourself in that situation.

Motherhood challenge: smug or just a bit of fun?

The #motherhoodchallenge sounds harmless, doesn't it? Some women disagree.

Who's the mum? Family photo goes viral

Last year, it was "The Dress". This year, it is a family photo that is breaking the internet.

5 easy meditation practices for beginners

So who's with me? You know meditating is one of the best things you can possibly do for yourself.

Woman to go on trial for being a bad housewife

An Italian woman could face up to six years in jail after her husband accused her of not doing enough cooking and cleaning at home.

Is the latest advice on women and drinking over the top?

While most expectant mums know to stop drinking when they’re pregnant, experts now warn women should stop drinking earlier than that. Is this necessary?

How household chores can double as a workout

If there's less than a slim chance you'll find time to get out for a jog or to hit the gym today, take heart in knowing that household chores contribute to the calorie equation.

I have no idea what I'm doing - and that's okay

Why don't we talk about the fact that when everything goes right, we may still feel completely lost, and certain that we have failed?

Dad warns of hair tourniquet danger after baby almost loses toe

A shocked father has shared his family's experience in a bid to warn other parents about the dangers of hair becoming entangled around a baby's toe.

Town welcomes first baby in 28 years

Since the 1980s, the Italian town of Ostana had not seen the birth of a single baby.

How to start teaching your kids road safety

It's something that can be taught as early as possible and reinforced as they get older and more mobile - even from toddlerhood.

Just announced: Bugaboo Cameleon³ Classic+ Collection update

Meet the brand new understated chic model from Bugaboo.

The emotional moment a mum hears her late son's heartbeat

It's been two and a half years since Heather Clark's seven-month-old son Lukas passed away.

Nine reasons why you have 'brain fog'

One minute your productivity is skyrocketing and the next you're sitting there trying to focus – just like that you draw blank, your brain, mush.

I had a caesarean and it was beautiful

Guess what? Despite not pushing him out, I cried, and my heart skipped, and I felt the rush of love and pride when I saw him for the first time.

 
Advertisement
 
Advertisement
 
 
 

What's hot on EB

Penny Wong

'The most hurtful argument in the marriage equality debate'

Labor frontbencher Penny Wong is used to to hearing arguments against same-sex marriage. But for Australia's most prominent gay politician, one hurts more than others.

Does exercise have to be fun to work?

Some things in life are inherently served with a big scoop of fun: balloons, bubbles, cupcakes to name but a few, but exercise?

Hair dye gives woman second-degree burns

She wanted a fresh colour for 2016, but instead she got chemical burns.

Kelly Slater saves mum and toddler from 'freak wave'

A Perth family has thanked US surfing "legend" Kelly Slater after the star saved a mother and a young toddler from "a freak wave" in Hawaii.

Apple recalls millions of power adapters

Tech giant instigates massive international recall of power point adapters due to risk of electric shock.

Toddler's adorable alphabet goes viral

It's impossible not to share this little boy's excitement  about the alphabet.

Tot's nighttime waking saves family's life

Like all tired parents, Monique and Kyle Ruppel were looking forward to the day their 15-month-old daughter Celia would start sleeping through the night. 

Australian mum gives birth to quintuplets

An Australian mum who has shared the ups and downs of carrying quintuplets has welcomed her five babies into the world.

Dad of four girls faints at gender reveal for fifth baby

It was all too much excitement for this dad.

The simple way you can help your baby's language development

The way parents respond to their child's babbling can shape how their infants communicate.

Zika virus is 'spreading explosively': WHO

The World Health Organization announced that it will convene an emergency meeting about Zika.

National database recommended for child protection cases

Baby Ebony was repeatedly failed by the agencies tasked with her protection before her horrific death at the hands of her father, South Australia's deputy coroner says.

Hospitals put babies at risk by ignoring policy on elective caesareans

Thirty-eight weeks or 39? Non-medical factors are pushing women to have elective caesareans earlier than official guidelines - and hospitals are playing along.

Police help deliver baby on busy roadside

Two police officers delivered more than a traffic fine by the side of a busy Melbourne road yesterday.

1D's Louis Tomlinson shares first photo of baby

One Direction's Louis Tomlinson has posted the first picture of his baby boy, Freddie, on social media.

 

FREE TICKET

See Hi-5 LIVE in Melbourne!

Get your ticket to The Essential Baby & Toddler Show - register online now!

 
Advertisement
 
 
Essential Baby and Essential Kids is the place to find parenting information and parenting support relating to conception, pregnancy, birth, babies, toddlers, kids, maternity, family budgeting, family travel, nutrition and wellbeing, family entertainment, kids entertainment, tips for the family home, child-friendly recipes and parenting. Try our pregnancy due date calculator to determine your due date, or our ovulation calculator to predict ovulation and your fertile period. Our pregnancy week by week guide shows your baby's stages of development. Access our very active mum's discussion groups in the Essential Baby forums or the Essential Kids forums to talk to mums about conception, pregnancy, birth, babies, toddlers, kids and parenting lifestyle. Essential Baby also offers a baby names database of more than 22,000 baby names, popular baby names, boys' names, girls' names and baby names advice in our baby names forum. Essential Kids features a range of free printable worksheets for kids from preschool years through to primary school years. For the latest baby clothes, maternity clothes, maternity accessories, toddler products, kids toys and kids clothing, breastfeeding and other parenting resources, check out Essential Baby and Essential Kids.