Medicare registration

Hi All,

I would like some advice about the Australian Heath Service.

I will relocate from the UK to Brisbane this coming Tuesday (15th) on a 457 visa. I have Italian and British dual citizenship.

A few weeks ago I have been to see my GP to investigate the reasons for some symptoms I have been experiencing in the past few months, and he prescribed some tests which I have done and all came up with negative results, so he still has no idea what could be the cause. The symptoms are persisting so he has recommended further tests which I will have to do in Australia. The GP told me that one of the possible causes, even though unlikely, is very serious so he recommended to have the test done at the earliest opportunity.

I believe that my OVHC policy would not cover the costs of these investigation because of the preexisting conditions clause; what is the best way of having the test booked as soon as possible? Do I have to register with medicare first, or can I visit a GP straight away just with my Italian and UK passports on the basis of the reciprocal agreements? I do not mind spending some money for a private consultation, but the test I have to undergo costs thousands of dollars so I would only do it privately if I have no other options.

Thanks in anticipation for the advice.

Hi @rustypie it is very hard to advise without knowing your condition and the tests they require. Personally if I was you I would be holding on in the UK and getting the tests and results before making such a huge move.

There are a few things you need to consider, ie if it is serious and you come out here how will you work, what would be your chance of gaining PR in the future, or are you just wanting to come out for a few years.

Although you can get Medicare I don't think they will cover you for investigations. However, say you had cancer and needed urgent treatment or were involved in a serious car crash you would be covered. That is my understanding but things change all the time so I may be wrong.

Even as a citizen there are tests that may be ordered that aren't covered by Medicare anyway. So you really need to know what the costs would entail.

Good luck and I hope all your tests give you positive news

Oddly enough I think you'll find that a pre-existing condition can only be one that has been diagnosed and that symptoms by themselves don't count. Doesn't mean the tests and treatment would be covered by medicare (there are other reasons which may mean they're excluded) but the condition wouldn't be excluded as a pre-existing condition if it was diagnosed in Australia. Insurance companies exclusion policies do include the symptoms of some specified illnesses (but only those) but as far as I know that doesn't apply to medicare at all.

This is an extract from my OVHC terms and conditions. It clearly refers to symptoms existing prior to joining the policy, not to conditions diagnosed before joining the policy:

What is a pre-existing condition?

A pre-existing condition is an illness or condition for which, in the opinion of a medical practitionerappointed by Westfund, signs or symptoms existed during the 6 months before the date you joinedWestfund or upgraded to a higher level of cover. A 12 month waiting period applies to all new Members forhospital costs relating to the treatment of pre-existing conditions.

Pom Queen, I've sent you a PM

Where are you going to be living is Brisbane?

From your pm I would say around $1,500 for the dr and anaesthetic and probably the same for the hospital fees, ie use of theatre etc.

Another option of doing it would be to present yourself at A and E with your symptoms. They may or may not do one this way.

Have you looked at the cost of having it done privately in the UK?

I have had the procedure 3 times here and I've had no costs but that's with health insurance and Medicare. Another thing to consider if you do still come out and go private ring various doctors (specialists) as their prices really do vary

This is an extract from my OVHC terms and conditions. It clearly refers to symptoms existing prior to joining the policy, not to conditions diagnosed before joining the policy:

 

What is a pre-existing condition?

A pre-existing condition is an illness or condition for which, in the opinion of a medical practitionerappointed by Westfund, signs or symptoms existed during the 6 months before the date you joinedWestfund or upgraded to a higher level of cover. A 12 month waiting period applies to all new Members forhospital costs relating to the treatment of pre-existing conditions.

The OP is asking about Medicare not Westfund. This is from Medicare:-

[h=1]Guideline for substantiating that a patient had a pre-existing condition at the time of the service[/h]

To substantiate that a patient had a specified condition at the time of the service you may provide:

• an excerpt from the patient's clinical file - clearly showing the patient's name, the date of the service and evidence of the existence of the condition. This may include:
  • a test result (for example: fasting glucose, HbA1c, spirometry report)

  • a diagnostic imaging report

  • a letter from a specialist or consultant physician verifying presence of the condition

  • sufficient clinical information, such as findings on history and examination, verifying presence of the condition

   

   

The Department of Human Services has no role in determining if the clinical opinion is correct as to the existence of the specified condition.

• any document created during or as soon as practicable after the service - that contains a reference to the condition existing, including a test result or note from another practitioner

• an excerpt from a GP management plan - clearly showing the patient's name, date of the GP management plan and a comment that the condition exists

In most cases, a patient's clinical information will be the only way to confirm that the patient had a specified condition

Sorry, I am getting a bit confused. Ignoring the other considerations about the kind of symptoms/conditions, my questions about this situation from a generic point of view are:

1) The symptoms existed before my arrival in Australia so the private OVHC insurance will not cover the treatment of the condition; is this true?

2) Can I have this done under medicare cover?

3) If yes, do I have to register with medicare prior to having the test done or is the UK/Italian passport sufficient for the reciprocal agreement cover?

4) I was not aware of any pre-existing condition clause for the medicare cover, does this mean that in general pre-existing conditions (irrespective from my condition being preexisting or not) are not covered from medicare?

5) If I do need to register with medicare, how do I do that?

I registered with Medicare as soon as I arrived as I knew I would need to see a doctor, you go to a Medicare service centre or sometimes they are in a Centrelink centre..just google your nearest one, fill in a form, show ID and they send you out a card and I think give you a temp one till it arrives...you can download the form and take it with you so it's already done as there can be long lines of people waiting to be seen...it's very quick and straightforward to register. if you go to a bulk billing gp they require your Medicare number to get free or low cost visits, blood tests etc. I have pre existing conditions that have been treated by Medicare. Google Medicare for more info, they have good website and once you are registered their services are online.

I registered with Medicare as soon as I arrived as I knew I would need to see a doctor, you go to a Medicare service centre or sometimes they are in a Centrelink centre..just google your nearest one, fill in a form, show ID and they send you out a card and I think give you a temp one till it arrives...you can download the form and take it with you so it's already done as there can be long lines of people waiting to be seen...it's very quick and straightforward to register. if you go to a bulk billing gp they require your Medicare number to get free or low cost visits, blood tests etc. I have pre existing conditions that have been treated by Medicare. Google Medicare for more info, they have good website and once you are registered their services are online.

Excellent, this is exactly what I wanted to know. If I understand correctly, this means that if I register as soon as I arrive, go and see a GP straight away and he prescribes to me the investigation I need to have, this will be covered by medicare even if the symptoms were pre-existing; is this right?

This is what you are looking for https://www.humanservices.gov.au/customer/enablers/health-care-visitors-australia

What I am unsure of is whether the procedure you mentioned is covered.

Looking at it I would say it is clinically necessary so you should be covered. Remember each dr's are different so if one says no keep asking.

Cheers, that it how I would interpret it. Unless there are exclusion for specific procedures or tests which are not stated in that page it would be covered.

I wonder what is the purpose of the Medicare definition of pre-existing condition in Ken's post. It defines in details the procedure for determining if the conditions is pre-existing but does not speak about the purpose of this determination?

This is how I see it and is what happened to me...I go to the doctors here same way I did with Nhs and seems same to me so far. Good luck

Thank you all for the advice, I was a bit agitated by this last minute recommendation from my GP, but I am much less anxious about it now!

It may well be that an Australian GP might not decide it comes under the reciprocal arrangement - if it could be considered necessary it might be but otherwise it could be considered elective. I'd be waiting and getting it done before you leave UK just in case! If you are coming as a permanent resident then this is irrelevant as Medicare covers everything. I would be hesitant if you are not permanent though

I have a copy of my medical records with a note from my GP recommending the test. I think that not many doctors would refuse to prescribe the test thinking at the risk of being sued for malpractice should the test results be positive........

I have a copy of my medical records with a note from my GP recommending the test. I think that not many doctors would refuse to prescribe the test thinking at the risk of being sued for malpractice should the test results be positive........

The problem is that you are only going to be a temporary resident - the reciprocity isnt total cover and it all depends on whether it is considered necessary or not - they could argue that you should get it done in your home country given that the suggestion has been made by them and you could have had it done there. Can you not get it done before you leave?

Not in a public hospital, it takes weeks just to book it and if I have to go private I may just as well do it in Australia. My flight is the day after tomorrow and I am expected to commence work on the following Monday.

The GP only told me about this test two days ago, all other tests came up negative but he has no idea what the cause of my symptoms is, therefore he recommended the test. In theory, the worst case scenario could be a life threatening condition so I would say it is not elective treatment....

After all, I am not particularly interested in having that test done but rather finding out what the cause of my symptoms is so I can take actions to cure it. If an Australian doctor finds out what it is without doing that specific test I am happy!