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Hufflepuff

Medicare Safety Net - Obstetrics no longer covered?

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Hufflepuff

I read somewhere (but I can't find or remember where!!!) the government has removed Obstetrics from the Medicare Safety Net.

 

Can anyone confirm if this correct?

 

If yes this will seriously effect my decision to go Public or Private as I'm not sure if I'm willing to pay all OB Fees without any rebate at all.

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~~nik~~

I claimed my huge ($2500.00) ob bill last week so it isn't in yet.

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mmuc83

you can still claim obstetrics, but the cap has been changed. i can't find the exact info at the moment, but i don't think it starts until 1 Jan anyway...

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mum2fj

oh god, that scares me if it is true! I am the same - trying to weigh up whether to go private again (which I loved last time) or suck it up and go public. My OB has increased her fees to $3500!

 

The other thing I am worried about and trying to find an answer - does the safety net apply to financial or calendar year? I have a baby due 31/12 and sure enough it will arrive early Jan. So I'm thinking that all my costs this year might not reach saftey net if bubs arrives in 2010?

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Hufflepuff

same here mum2fj

 

I think I am due in Feb 2010 (going for blood test tomorrow to confirm pregnant for sure).

 

So anyone who gets pregnant going forward will need to keep this in mind.

 

Wish I could find out what the cap is and if it's means tested at all!

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Missy83

safety net is calendar year

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Georgie01

Not sure whether it's all finalised yet (???) but here's an outline...

 

Under the changes, from January 1, 2010, the safety net will pay only a set amount for Medicare services for obstetrics, IVF and four other treatments.

 

Previously, the safety net would pay 80 per cent of the difference between the standard Medicare rebate and the doctor's private fee, once the patient had shouldered a threshold amount in out-of-pocket payments each year.

 

Instead of an open-ended entitlement, women will now get back only a maximum of $200 from the safety net for a Medicare item used for the planning and management of a pregnancy -- an item for which some obstetricians had been charging private fees of several thousand dollars.

 

Other caps apply to the other 55 obstetrics-related Medicare items, and to the nine Medicare items for IVF services and four other assorted items.

 

Here's the full article medicare changes

 

Found the official, very detailed site (edit problems, see later post)

Edited by Georgie01

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Missy83

After reading what some of your obs charge I can understand why the government is bringing this in. I went private to have DS with one of the most respected high risk OB's in my state and she charged $40 per appt & $500 delivery fee (which I thought was bad enough at the time, but worth it after the horror public experience I had with DD)

 

I can't imagine paying $2500-$3500!!! :o

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coco100

For those of you worried you might deliver after 1 January, cant you just pay your OB fees before the end of the calendar year?

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Hufflepuff

Georgie01 thanks for that. You are a better googler than I am :p

 

That seriously scares me! My OB last time (Sydney) charged $5,000 + for my pregnancy care / delivery.

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Guest paddington13
For those of you worried you might deliver after 1 January, cant you just pay your OB fees before the end of the calendar year?

 

Usually the pregnancy management fee is paid at 20 weeks from memory? So as long as you pay it and submit it to medicare before the end of the year I think (?) you should be OK. I didn't get any rebate for the delivery fee (which is later) anyway, and the management fee is usually a lot more. This topic might be on EB somewhere else.

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**Mother-2-2DDs**

For what its worth, so long as the date of actual payment is b4 the end of the calender year u can claim the 2009 entitlements, which is still 80%.

 

You can also ask ur Ob to bill you all b4 the end of 09 and pay b4 09's end. Long as the receipt is dated in 09 - you r fine.

 

Bloody Rudd! Screwing up Medicare, then Private health insurance rebate too! What a d*ck! :rant::rant::rant: (Sorry he makes me SO damn mad) - doesnt make it easy 4 the aerage person/family.

 

Good luck with it all.

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PurplePaperFrog

This is just going to push more people from the private sector into an already crowded public system...no one wins...

 

Maybe OB's will be forced to lower their fees in future to get more clients?

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SuperRev

damn, our 20 weeks is due on the 11th Jan.

 

I'm weighing up the benefit at the moment of asking if I can pay at 18 weeks, or just paying on the 11th Jan, with the being over the threshold for the rest of the year.

 

Its $1800. If we have currently had no out of pocket expenses, will we get 80% back of the whole lot or just the amount over the threshold of $1111.60?

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Veritas Vinum Arte

The Medicare Safety Net also DOES NOT cover in hospital treatments so if your OB charges a 'gap' at the end process this WILL NOT be covered AT ALL by the medicare safety net.

 

My anaethetist bills were the killer...... over $700 out of pocket as the MSN does not apply in hospital :(

 

 

SuperRev - the 80% back is once you have reached the OPE threshold. So if you no OPE you would potentially get $200 for the medicare rebate (leaving you with $1600 OPE) then subtract the $1,100 threshold leaves you with $500 of OPE of which you would then get 80% back, so you would at a maximum get about $400 back from your $1800 bill (pre 31 Dec).

 

 

 

 

 

 

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SuperRev

Thanks, I'll do the sums and see if paying now has more benefits then paying next year.

 

I'll also ask the doc about gap stuff.

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seepi

It is mainly the 20 week pregnancy and management fee that has been removed from the safety net. You can't pay this until you are officially 20 weeks pregnant. So if you are 20 weeks within 2009 you are ok, but if your 20 weeks falls next year, then you will not get safety net rebate on your OB payment.

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Missy83
SuperRev - the 80% back is once you have reached the OPE threshold. So if you no OPE you would potentially get $200 for the medicare rebate (leaving you with $1600 OPE) then subtract the $1,100 threshold leaves you with $500 of OPE of which you would then get 80% back, so you would at a maximum get about $400 back from your $1800 bill (pre 31 Dec).

 

My understanding is this:

You pay $1800

Safety Net is $1111.60

So $688.40 over safety net threshhold.

Under the current system you would get 80% of this back ($550.72)

Under the new system (1/1/10) you will only get a maximum of $200 back.

 

So you are $350.72 better off to pay it in 2009.

 

This was how it worked with my private bills anyway.

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seepi

Hmm - although the rebate is ow if you can.only 200.00 for Preg and mngt fee now, presumably the entire fee still contributes to medicare safetynet threshold. So if you paid next year you would be already qualified for safety net for any other medical expenses all year.

 

But for ob fee of 3-5,000 it is definitely worth it to pay now.

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Lokum

I've already reached the safety net this year through IVF treatments. However, I'll only be 13 weeks at the end of this year.

 

My obs fee for pregnancy planning and management is $3500. I asked if I could pay this year, and not wait until 20 weeks, but apparently it's a Medicare rule that you can only be charged under that item number at 20 weeks and not before.

 

However, there's still some lack of clarity about how obs may re-structure their bills in 2010 under a variety of item numbers to maximise the refund we can get.

 

We'll see. (Still happy to be stuck with obs fees rather than IVF fees!!!!!)

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jm3
I've already reached the safety net this year through IVF treatments. However, I'll only be 13 weeks at the end of this year.

 

My obs fee for pregnancy planning and management is $3500. I asked if I could pay this year, and not wait until 20 weeks, but apparently it's a Medicare rule that you can only be charged under that item number at 20 weeks and not before.

 

However, there's still some lack of clarity about how obs may re-structure their bills in 2010 under a variety of item numbers to maximise the refund we can get.

 

We'll see. (Still happy to be stuck with obs fees rather than IVF fees!!!!!)

 

I was in exactly the same situation as you two years ago. 13 weeks at the end of the year. My ob let me pay early, but I'm sure he wasn't meant to. Not complaining though.

 

 

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Ingride1

Hi all.

 

I am new here, but have been following this situation very closely as I am due in June 2010. Have been seeing my private obgyn with no warning that this change was coming. So after a quick phone call to medicare to ask about safety net they informed me of these changes taking place next year. They could not give me all the info so I spent hour and hours until I spoke to the right people - phone calls to centrelink, medicare, visits to my obgyn and medicare office.. i now have all the info that will hopefully help a lot of you.

 

Firstly here is the offiicial web site detailing all of the changes. MBS Online - Changes to the Extended Medicare Safety Net in the 2009-10 Budget It is a little confusing at first so I am happy to answer any questions. This will impact those mostly in regards to the planning and mamnagement fee (item #16590) All costs met by you this year will remain the same in regards to the safety net, being that if you have reached your safety net then you will still get 80% of out of pocket expenses back, so try to see how much you can get paid this calender year. Your obgyn will not legally be allowed to invoice your planning and management fee until you are officially 20 weeks. I fall two weeks short of this!! Best thing for you to do, is to talk to your obgyn's accounts person and make a rough list of how many apointments you will still require assuming all goes smoothly - at this stage standard antenatal appointmets item no. is #16500, get any other scan or appointment item numbers you could possibly need and a list of the dr's current fees for each item. I have done this and made a list of each cost for each item number. Item numbers may change slightly next year as may you dr's charges, but they are likely to go down if anything and not up. So if you roughly base all your info on current charges you will get a bit of an idea of what you are up to.

 

Basically each out of pocket expense you pay (the difference between the medicare scheduled fee and your dr's charge) will go towards meeting your safety net - same as this year.. that has not changed (In hospital expenses however do not go towards safety net). If you recieve family tax benefit A, your safety net threshold will be $562.90 per couple or family. If you do not recieve family tax benefit A your threshold will be $1126.00. So you have to reach these figures in out of pocket expenses before you are entitled to recieve the new cap amount. If you have not reached your saftey net, you will only recieve the standard medicare rebate - (which is 80% of the sheduled fee) If you have reached your saftey net, you wll recieve both the medicare rebate + the capped amount for that item no. There is alittle bit of good news (only a little) and that is that they have raised the sheduled fee on many item numbers relating to obstetrics and IVF, so even if you only get the rebate, it will be a little more than it used to be. The bad news is that for the really big bills (ie management fees) you can only get the maximum cap amount + rebate which is for most a lot less than the 80% out of pocket which it has been up until end of Dec.

 

For example.. my first bill for the new year in Jan will be my managemnet fee which is $1350. So according to the web site I have provided I have gone right down the page until I found the item number (16590) there are 5 colums showing different $figures. the first $ amount is the scheduled fee for this item number currently, the next colum shows what the new sheduled fee will be as of 1st Jan 2010, the next column shows what your reabte will be if you have not yet reached your safety net, the next column shows the capped amount you will ALSO recieve if you have reached your saftey net. The last colum shows the total amount you can recieve if you have reached your safety net (rebate+cap amount)

 

So for me $1350 minus 2010 scheduled fee ($306.30) means that I am paying $1043.70 out of pocket and as I have the lower safety net threshold ($562.90) I have therefore reached my safety net and will recieve the rebate + cap amount = $463.40. I fI had the higher safety net threshold of $1126.00 I would not have quite reached my safety net, therefore the max amount I would get back would be only the rebate =$260.40

 

As far as the rest of my antenatal visits go, and scans, based on what my dr charges and the fact that safety net is reached Iwill recieve both rebate and cap amounts, which will not be too bad. But it is all relevant to what your specialist is charging above the scheduled fee. So get your item numbers and Dr's charges and try to give yourselves a rough estimate if you can, of what your out of pocket costs might be..going off the web site I have provided and the charts on it. Remembering of course you obgyn could very well change his fees and item numbers - if they do they should be only doing so to try and get you the maximum benefit they can. As this will affect their clientel greatly, so they will have to try and do the best by you that they can to keep you on their list!

 

The other thing very important to check with them, is what they are doing in relation to the actual in hospital delivery. I am yet to confirm this, as up until now my dr has always accepted my health fund and medicare rebates as full payment so I have not had any out of pocket expenses for the hospital. Also check with anaethstists for possible out of pocket charges and item numbers, as all in hospital out of pocket expenses do NOT go towards your safety net, and the maximum amount you can get back is the rebate only (the 3rd $amount column in the charts)

 

I really hope this has helped maybe even one person and not confused anyone too much. The bill was only pssed on the 9th of Dec so it is all very new, even the Medicare office were blank faced about it until I spoke to the supervisor. Please ask if I can help clarify anything for you at all, and if I have put way to much iformation here and it makes no sense.. I AM SORRY!!!

 

Ingrid :rolleyes:

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jm3

I was fortunate that my ob let me pay my p & m fee at 13 weeks a couple of years ago to maximise my safety net. Legal, probably not, but I didn't argue when the accounts person said I could.

 

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bubba-licious

I just talked to DF & this basically will mean that we will be going public now unless the OBYN's lower their fees I don't see how we will be able to afford to be that much out of pocket right when we will be going down to one income & need money the most.

 

I thought they were trying to fix the public health system? What a joke. :xmas_angry:

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