[bluecupcakes]

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!

[Beltie]

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

[bluecupcakes]

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!

[WinterDancesHere]

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.

[FoxyRetro*Gal]

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

[Tesseract]

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

[Justaduck]

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

[K+M+A+P]

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.

[bluecupcakes]

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!

[purple_daisy]

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.