Private Health Insurance & IVF

**Missy14** · 28-06-2011 14:10

Hi everyone

I'm hoping that someone/anyone can help me!
I was booked in to have Tubal Ligation Reversal done next month but now DP and I have decided that we may be better off TTC using IVF instead as we only want one more child and DP is worried that after TLR we may end up with more than one (surprises).
I have researched as much as possible and know roughly what costs are involved and that it can vary a lot depending on where you go, I have also read that medicare covers a fair amount of the costs (?).
My questions are- Is it worthwhile having private health insurance to cover the hospital fees? Or the gaps that medicare don't cover?
I've never had PHI so I know that I would have to wait at least 12 months (sigh) before starting the process. Another question I can't seem to find an answer for is if TL would be considered a pre-existing condition and whether that would impact on PHI or not?!
Any insight or personal experiences would be much appreciated!!

**moomechanic** · 28-06-2011 17:13

hi
TL would most definately be classed as preexisting, because you already have it, infertility in general is classed as pre existing whether you know you have it or not, even the unexplained kind, so TL would definately be.

As for PH, we have it but dont think it is worth it, the only reason we keep it, is because at the moment IVF is publicly funded, so you dont need it, if the government were to pull the funding then you would be paying for IVF plus the hospital stay, surgery etc as that is all PH covers, the IVF part still costs you exactly the same. So at the moment we pay the IVF fee, when our PH waiting period is up, we pay IVF = $250 which is our PH excess, so you actually end up paying more per cycle not less plus the cost of you PH cover.

Hope this makes sense?! Goodluck!

**vesper** · 28-06-2011 17:30

I'm in melbourne and there are no public ivf clinics so if we didn't have PHI it would cost an extra 1500 or so each cycle for hospital stay and anesthetist. They also cover a little of the doctors fees. We have no excess for a day stay. So if you have success after one round it might not be worth it, but we are up to round 4 so it's saved us over 6K so far...

**nicole83** · 28-06-2011 19:55

Vesper which phi are u with? That is good they don't charge for day stay, mine do (medibank pvt)

**tjayne** · 28-06-2011 20:18

You can claim back some of your meds on PHI - like the syneral and progesterone.

But I do need to pay the excess if I go into hospital for EPU for the day.

**vesper** · 28-06-2011 20:19

I'm with HCF. I've only ever used them for ivf, I only have hospital, not extras. But they seem good, and the hospitals I've had epu in have been completely covered by them

**saskiasmum** · 28-06-2011 20:56

Originally Posted by vesper

I'm in melbourne and there are no public ivf clinics so if we didn't have PHI it would cost an extra 1500 or so each cycle for hospital stay and anesthetist. They also cover a little of the doctors fees. We have no excess for a day stay. So if you have success after one round it might not be worth it, but we are up to round 4 so it's saved us over 6K so far...

I agree
I'm in Melbourne too and having the PHI has definitely helped

**saskiasmum** · 28-06-2011 20:57

Originally Posted by nicole83

Vesper which phi are u with? That is good they don't charge for day stay, mine do (medibank pvt)

I'm with Medibank and never had to pay for day stay

**Missy14** · 29-06-2011 11:12

Originally Posted by moomechanic

hi
TL would most definately be classed as preexisting, because you already have it, infertility in general is classed as pre existing whether you know you have it or not, even the unexplained kind, so TL would definately be.

As for PH, we have it but dont think it is worth it, the only reason we keep it, is because at the moment IVF is publicly funded, so you dont need it, if the government were to pull the funding then you would be paying for IVF plus the hospital stay, surgery etc as that is all PH covers, the IVF part still costs you exactly the same. So at the moment we pay the IVF fee, when our PH waiting period is up, we pay IVF = $250 which is our PH excess, so you actually end up paying more per cycle not less plus the cost of you PH cover.

Hope this makes sense?! Goodluck!

Thanks for your replies ladies!

Moomechanic, that's what I was thinking, that PHI wouldn't really be worth it and that Medicare covers a fair amount, plus I'm slightly against having to wait 12 months lol

If it makes any difference, I currently live in Melbourne but am relocating at the end of the year to south east Queensland. From all the research I've done I'm pretty sure we will travel to westmead for treatments, not entirely sure how to go about it though. Has anybody been to westmead, and had to travel to appointments/treatments etc? If so, how long did the process take/how much travel to Sydney did you have to do? Any information would be fantastic

**second baby not so easy** · 29-06-2011 11:24

Hi,

Im in Adelaide and with Mutual Community and PHI has really helped, we done ICSI and cycle is around $4000, which we have to pay upfront, 1st cycle of the calander year I get back from medicare $1500 and second etc cycles still $4000 upfront but we get back $2300 (apprx) so our PHI didnt cover this. But hospital visits were covered and we didnt have to pay for this which is over $1000 per cycle. For us I am glad we have got it. PHI doesnt cover as much as it should though - appointments with FS are not covered. But we saved just with IVF $2900 just alone and we pay about $2600 a yr in PHI.