Cancer, IVF, Medicare and private health queries

[kmmr]

Hi,

 

I'm an Australian moving back to Sydney next year with my english husband. I've been away for about 8 years so I can't really remember how things work with health care. Plus I never had much reason to be involved other than the odd cold, but things have changed.

 

I was hoping that the combined wisdom here could help me with some questions.

 

First - a bit of background:

I've had successful treatment for cervical cancer this year. In remission since Feb, but still subject to three monthly follow ups and 6 monthly MRI's. It's expected that as I get older I would need a full hysterectomy to be safe, but they are allowing me a few years with just monitoring so I can try to have kids.

 

To do that, I need IVF, and probably a few minor operations during that process. So would require a couple of hospital stays at a minimum. I'm 37, and will be 38 when I get back so I can't wait too long for all this.

Questions: I know people can't really answer these with certainty, but I'd love to get any experiences or knowledge that is around.

Cancer follow up: Would this normally be done within Medicare, and what would it cost? I know MRI's can be extremely expensive, but I'm not sure how much I'd have to pay. My oncologist here will hand over my care to a friend/colleague in Sydney, who I presume will charge private rates too.

 

If they advised in a few years to do the more comprehensive operation, would Medicare also cover that?

 

IVF: I know that Medicare provides support for IVF. Does anyone have experience of how this works, and how hard it is to get funded. In the UK it's a bit of a nightmare with long waiting lists, and you only get one 'go', but I'm not sure how it works in Australia. I'd love advice from anyone who has been through this.

 

My Mum has told me that there is a cap with Medicare, over which more of the costs are paid, but could anyone advise if that applies to things like IVF?

 

Private Health: What additional cover does Private health give me. I presume I'll be exempt for 12 months or so for both the IVF and the cancer costs, but after that would they cover me do you think? Both are clearly pre-existing conditions, and expected to cost a lot in the short and long term, so I'm worried I'll just be declined.

 

When I lived in Australia I was a member of HCF, which I maintained for a year even after I left, but I'm not sure if that helps at all.

 

Thanks in advance! This is quite a stressful thing for me as you can imagine, and I can't decide if we should activate our visa and then stay a while here in the UK where I understand the system more. But at the same time I want to get home to my family.

[northernbird]

I would imagine your cancer follow ups would be covered under medicare no problem at all. Some specialists will charge more than the medicare rebate so you would have gap, some private health plans may cover this gap. Ensure you get copies of your medical records to bring with you and perhaps a letter from your oncologist.

 

As for IVF I found this website just doing a quick google http://ivf.com.au/ivf-fees/ivf-and-medicare

[newjez]

I would also be interested in any input on this.

[Guest]

Can't help with the Aus side but if you are considering starting a family you should research your IVF options in the UK asap as last I heard it isn't just a one time deal. If you are needing IVF because your treatment for cancer caused fertility issues I am sure there is a way to get onto the IVF programme. You should speak with your GP or doctor at the hospital as they should be able to refer you through the system.

 

http://www.nhs.uk/Conditions/ivf/Pages/Introduction.aspx

 

If you started IVF in the UK and it was successful there is nothing to stop you heading back to Aus a little later on in the pregnancy. Or after a course of it if it did not work. I don't know wait times as each area varies but its worth looking in to to see if you can get started at least. No harm in trying I reckon, especially if you are not returning to Aus in the immediate future.

[kmmr]

Hi all,

 

Thanks for the responses.

 

I've seen that price list from IVF.com.au and that is the clinic I would probably use. I'm just wondering if there is anything I have to do to 'qualify' for those rebates - or do I just need a referral from the GP. It may be that I can't find information as it's not a relevant question. In the UK you can only get help if your BMI is correct, and your overall health means you have a greater than 30% chance of success. Otherwise you pay it all yourself. It's a brutal system to be honest!

 

So I'm just wondering if there is any such requirement in Australia. It looks like there isn't, but would be interesting to hear of experiences.The thing is in the UK it's 100% free if you qualify, so they make it harder to qualify. I suppose the need to part pay in Aus controls that a little.

 

My concerns are also around extra costs. Specifically I will need an additional operation during the IVF process as my anatomy is 'non-standard' these days. I'm not sure if these are covered by medicare. It's not fertility treatment per-se, but it's necessary treatment to allow the IVF to work.

 

Re the UK - I am going to try IVF here before I go. I've had some embryo freezing prior to the cancer treatment, and will give the NHS a go pretty soon. The amount of tries you get depends on your local health trust, and for my area it's one only. You also have to have BMI < 30, no children (either partner), no more than 3 private cycles in the past, generally good health, acceptable 'male factor' levels etc, etc. I've actually got an appointment tomorrow, so fingers crossed.

 

If I get pregnant I can't travel as it will be a high risk pregnancy from day 1. So it's really hard to decide what to do!

[kmmr]

Hi all,

For anyone else researching I thought I would update this.

IVF: In order to qualify for the medicare rebates you just need to have a card, a medical condition that is effecting your fertility and be under the age of 52. The clinic have said that just means you need a referral from your GP. "Unexplained infertility" is an acceptable medical condition for referral.

Private Health: You can start your cover prior to arrival in Australia to get started with waiting periods. Also, if you have private cover in the UK ask your Australian provider if they take this into account when you move over. I'm with Norwich Union Health, and HCF recognise them, which means I can get continuous cover, and don't have to serve your waiting periods for anything I was covered for in the UK. So that is great for my cancer cover, no worry about pre-existing conditions.

 

My UK cover doesn't include anything for IVF (none of them do) so I would have to do the waiting period for that. If I start cover now I would end up paying over $3000 in premiums before I even arrive, so it may be cheaper to pay for one or two day surgeries necessary for IVF, if I do it before the waiting period is up.

 

They have confirmed that my likely complex obstetric treatment (if I get that far) will be covered. Anything 'medically necessary' will be covered.

[fish.01]

...

Private Health: What additional cover does Private health give me. I presume I'll be exempt for 12 months or so for both the IVF and the cancer costs, but after that would they cover me do you think? Both are clearly pre-existing conditions, and expected to cost a lot in the short and long term, so I'm worried I'll just be declined.

...

 

A few notes:

 

- It is illegal for a private health insurer to decline you coverage for a pre-existing condition in Australia. They can only apply waiting periods.

 

- Private hospital insurance only covers hospital costs..ie, procedures (eg IVF) performed in a hospital or day-hospital. It doesn't cover visits to private specialists etc. (note: non resident/temp resident private insurance may differ in this regard)

 

- Medicare pays a partial rebate if you see a private specialist. If you see a public specialist in a public hospital outpatient clinic medicare pays all of it but waiting times can be acceptable or unacceptable depending on hospital and supply/demand in that speciality.

[Malkitek]

Hi,

I am in Adelaide so a different ivf clinic, but my uk experience to aus is night and day. We are being treated in a private clinic which is part of a public hospital. The access is fantastic, was virtually impossible for us in uk as hubbie works offshore but they have bent over backwards for us here. Very professional and honest. Our clinic bulk bills half cost then we pay half and get various amounts back on Medicare too. Get more back the more you spend in a year! Our clinic is now trialling bulk billing so our next frozen cycle we won't pay anything! And this started ten months after we arrived in aus as permanent citizens.

Good luck

Gill x

[Petals]

With private health if treated in a hospital you will have gap fees and these can be quite large depending on if you have gap insurance and are using doctors and hospitals that are on the funds list. I have paid out hefty amounts for both my recent operations in a private hospital despite having top cover.

 

Also if you need surgery in a public hospital the wait time will depend on the urgency of the procedure and of course if other more urgent cases come along you get bumped down if not life threatening etc.

 

My daughter has ongoing treatment for her brain cancer and her mris which she chooses to have once a year now are bulk billed. She did not pay anything for her treatment save the medicare levy which is deducted from her wages. However with her diabetes and she is type 1 her specialist charges over a hundred dollars gap every time she visits. She does not have private health as she would have to pay so much extra in gap for her diabetes and with the cancer she gets the top people anyway through the public because of the type she has.

[fish.01]

With private health if treated in a hospital you will have gap fees and these can be quite large depending on if you have gap insurance and are using doctors and hospitals that are on the funds list. I have paid out hefty amounts for both my recent operations in a private hospital despite having top cover.....

 

Yes, and on this note you can ask whether a private specialist will take you on as a No Gap patient when charging you for your hospital admission. Most funds have some sort of No Gap scheme where they list specialists that have taken No Gap patients before.

 

There are no guarantees but I have found most of the time we have been accepted, including our IVF treatment but as petals noted your YMMV. Under a No Gap scheme the specialists fees for your hospital medical procedure are fully covered by a combination of the standard medicare rebate and your private hospital insurance. The specialist is agreeing to not charge you a gap, or to charge a small capped gap, on top of this.

 

Note that any other specialists used may also treat you on a No Gap basis or may not...this is something you need to discuss...eg Anaesthetists.

 

Here is an example of my private insurers Gap Cover scheme:

 

 

 

"How exactly does GapCover work?

 

 

Under GapCover, the maximum amount you can be out-of-pocket – or the maximum gap – for treatment you have during a hospital admission is $500 per doctor.

In many cases, there’s no gap at all.

 

In 2009, 89% of Medibank GapCover claims had no gap ie. no out-of-pocket expenses

(Based on 2009 calendar year data for Medibank Private GapCover in-hospital medical claims)

 

Where a doctor agrees to participate in GapCover, we pay a higher fee for the procedure. This means that the total amount the doctor receives from us and Medicare for your treatment is more than the MBS fee – we’ll call this the ‘GapCover Fee’. In return, the doctor agrees to limit or eliminate the gap they charge you.

 

This means, if your doctor agrees to participate in GapCover, there are two possible scenarios:

 

Your doctor charges the ‘GapCover Fee’ for the treatment you receive in hospital= no gap for you

 

OR

 

Your doctor charges above the ‘GapCover Fee’ for the treatment you receive in hospitala limited gap amount for you of no more than $500 per doctor = a limited gap amount for you of no more than $500 per doctor.

 

You can see that, by choosing a doctor who’ll use GapCover, you can limit or even avoid a gap. Having no gap at all means no out-of-pocket expenses for in-hospital medical services. Having a limited gap means your in-hospital medical out-of-pocket expenses are capped.

There are a couple of things it’s important to be aware of about GapCover. First, it’s entirely up to your doctor whether they’ll participate. Second, they can decide to participate on a case-by-case basis."

 

 

Read more (PDF): http://www.medibank.com.au/client/documents/pdfs/gapcover.pdf

[gpo1971]

Ivf in Australia is a much better experience than in the UK. The initial costs are expensive but I think you get about 80% back through medicare. You have to be PR or citizen though.

[Petals]

Problem is with gap cover you are really not getting doc of your choice, its the health funds preferred or chosen one. When I had my knee replaced I paid a lot over the odds for my new knee and when I went to the pre op lecture I was the only one who had my surgeon. All the others had the same surgeon and its pretty obvious he was the chosen one of the funds. I am so happy with my result though and everyone was amazed how well it healed and works and they keep saying do you still have pain and no I don't. You see you get what you pay for in the private world same all over really. This surgeon was highly recommended by my GP and a friend of hers and he was great.

 

I take the view that if I can afford private health then I need to afford the gap myself so that I can get the best care I can.

[fish.01]

Problem is with gap cover you are really not getting doc of your choice, its the health funds preferred or chosen one. When I had my knee replaced I paid a lot over the odds for my new knee and when I went to the pre op lecture I was the only one who had my surgeon. All the others had the same surgeon and its pretty obvious he was the chosen one of the funds. I am so happy with my result though and everyone was amazed how well it healed and works and they keep saying do you still have pain and no I don't. You see you get what you pay for in the private world same all over really. This surgeon was highly recommended by my GP and a friend of hers and he was great.

 

I take the view that if I can afford private health then I need to afford the gap myself so that I can get the best care I can.

 

Yes, could be that you have a preferred one that isn't listed or that won't do it....has never happened to me but of course does happen.

 

Just to add to what I said before a doc doesn't have to be listed for you to ask if they will treat you as a No Gap patient...a couple of times we have not even bothered checking if they are on the list when we have already decided on a very highly recommended doctor...just asked and they have agreed on the spot.