Pregnancy Management Fee- Medicare Refund..

**MumDadBoyandGirl** · 14-03-2012 20:01

I've tried looking at old posts and the medicare website but I'm no closer to understanding if I will get anything from my private OB fee of $1230?

These are the details I've found on the medicare website, but I'm curious what others got back from medicare for this fee??

16590
Planning and management of a pregnancy that has progressed beyond 20 weeks provided the fee does not include any amount for the management of the labour and delivery, payable once only for any pregnancy that has progressed beyond 20 weeks where the practitioner intends to undertake the delivery for a privately admitted patient, not being a service to which item 16591 applies.
Fee: $318.05 Benefit: 75% = $238.55 85% = $270.35

Extended Medicare Safety Net Cap: $216.85

**kpet** · 14-03-2012 20:05

When pregnant with DS I definitely received a Medicare rebate, either the standard or slightly higher. I think I had passed safety net by then. Mine was about $1200 too. Medicare works on codes. You could ask your dr or the receptionist for the code on the bill and then check with Medicare. Good luck

**Mrs E** · 14-03-2012 20:06

My OB's fee was around $1600 and I think I got about $500 back from Medicare

**Manny** · 14-03-2012 20:20

The rudd govt made some chahges & now i think max you get back from medicare is aprox $400. My P&M fee was $2500 & i got $400 bacl

**MummaOJ** · 14-03-2012 20:33

Manny is right, it is around $400 regardless of safety net or the amount the ob charges. When I had my first I got back majority of p&m fee, this time only $400. Obs can now charge what they like too.

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**Pesca77** · 14-03-2012 21:33

Yep, rebate is just over $400 now. Geez, my OB was $4,500, so you've got yourself a good deal there!

**bohogirls** · 16-05-2012 19:14

Just over $400 because the government put a cap on it. I love how politics work - give with one hand for paid Mat leave but take away with the other by capping Medicare rebates!

**headoverfeet** · 16-05-2012 19:16

Originally Posted by bohogirls

Just over $400 because the government put a cap on it. I love how politics work - give with one hand for paid Mat leave but take away with the other by capping Medicare rebates!

Um it was capped in a bid to stop OBs ripping the public off. Personally I'm glad it's got a cap on it, you choose to go private don't expect tax payers to pay for it.

Why are some services capped?
Following an announcement in the 2009-2010 Budget, on 1 January 2010 some Medicare items were capped after they were identified as areas of concern in the Extended Medicare Safety Net Review Report 2009 (the Review report). The Review report showed that for some services, such as obstetrics and assisted reproductive technology (ART), the EMSN had been used by specialist doctors to raise their fees knowing the taxpayer would cover 80 per cent of the fee rise. This has implications for people that have not qualified for the EMSN. The EMSN benefit is intended to be a patient benefit; it is not intended to be a mechanism for doctors to increase their fees.

Since 1 January 2010 a number of MBS services have since been listed on the MBS with EMSN benefit caps in place. These services have been capped to maintain consistency with the existing capped items, or as a result of recommendations made by the Medical Services Advisory Committee (MSAC) regarding cost effectiveness.

http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-EMSN-1_Jan_2012

**Izy** · 16-05-2012 19:37

Des could always charge whatever they like

sent from the phone even my 2yr old rejected!

**bohogirls** · 17-05-2012 09:40

Originally Posted by Thermolicious

Um it was capped in a bid to stop OBs ripping the public off. Personally I'm glad it's got a cap on it, you choose to go private don't expect tax payers to pay for it.

Why are some services capped?
Following an announcement in the 2009-2010 Budget, on 1 January 2010 some Medicare items were capped after they were identified as areas of concern in the Extended Medicare Safety Net Review Report 2009 (the Review report). The Review report showed that for some services, such as obstetrics and assisted reproductive technology (ART), the EMSN had been used by specialist doctors to raise their fees knowing the taxpayer would cover 80 per cent of the fee rise. This has implications for people that have not qualified for the EMSN. The EMSN benefit is intended to be a patient benefit; it is not intended to be a mechanism for doctors to increase their fees.

Since 1 January 2010 a number of MBS services have since been listed on the MBS with EMSN benefit caps in place. These services have been capped to maintain consistency with the existing capped items, or as a result of recommendations made by the Medical Services Advisory Committee (MSAC) regarding cost effectiveness.

http://www.health.gov.au/internet/mb...MSN-1_Jan_2012

The cap then needs to be placed on what doctors charge.

Some are charging exorbitant amounts in management fees and for what?

Non-fat lattes and iced vo-vos during prenatal visits? I don't think so.

You are getting same care he/she is obligated to provide as an OB who doesn't charge a management fee.

You could be paying $4.5k on an OB who's nothing more than average in his field just because he can.

Yes it's your choice to use a particular doctor but for a lot of anxious first time mothers or those uneducated in how the health system and private health works, the desire to have the best care can take over.

Moreover, just because you have private health insurance does not make you exempt from paying tax.