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  1. #1
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    Default New to Australia but not RI. Questions about coverage.

    Hello ladies,

    I am a new permenant resident to Australia. Husband is a citizen. I used reproductive immunology a while ago. I am from the USA so I used the doctors that pioneered the field of medicine. I know that Dr. Gamal Matthias is the reproductive immunologist here in Australia. I feel lucky to have him as real reproductive immunologists are rare, even if the USA.

    Can someone tell me how IVF works in Australia with the medical system? I don’t understand it quite yet. In the USA I paid all out of pocket for ivf and all meds needed, but my reproductive immunologist was treating me for auto immune issues which happened to cause infertility/recurrent miscarriages and so all was covered by health insurance except for IVIg. I was in a blood thinner called lovenix, a thyroid medication, prednisone and IVIg plus a prescription prenatal and a slew of other vitamins. The most expensive was the IVIg which was around $3000 per infusion. I think I had it at least once per month.

    I am happy to answer any questions about reproductive immunology that I can to contribute. I’ve been through the ringer.

    Thanks ladies xo

  2. #2
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    Assuming you have Medicare coverage, but not private insurance:
    If you have been medically diagnosed as infertile, every time you do an egg pick up or transfer, the government will pay a certain amount for that service. Most clinics charge over this amount, for which you will pay out of pocket. Some treatments have no government funding, and will be completely out of pocket. Often, you will pay all costs upfront and then the government will give you the money back afterwards. Another case, they will process the claim and you just pay the difference between the service and the government rebate.
    If you have hit Medicare safety net thresholds (you'll hit this after paying something like $2,000 out of pocket in a calender year), you'll get a bit more back from each service. The threshold resets every year.
    If you have private hospital insurance, they will (likely) pay part of the costs for egg pick up (Assuming you have reproductive and birth related coverage). Private hospital insurance only covers in patient services, so no medications, scans etc done as an outpatient. If you have "extras" private insurance, you can claim some medications, but there is a limit to how much you get back per year.
    There's quite a lot to explain, so hopefully this is easy to understand and perhaps gives you some areas where you might wish to ask more specific questions

  3. The Following User Says Thank You to SJ565 For This Useful Post:

    2ybabes (19-04-2019)

  4. #3
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    Thank you. Sounds complicated. I was kind of expecting to just pay anyways. What is egg pick up? Is that when they put you under to retrieve the eggs? Would you say it’s just better to get private insurance? At home private insurance doesn’t cover ivf if you buy it as an individual but ivf is covered partially or fully if you get the insurance through your work. Medical assistance ( so through the government) won’t cover anything.

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    Egg pick up is same as egg retrieval.
    For IVF, it's not really worth getting private health insurance (PHI). You'll pay a lot more in premiums than you would get back.
    But you may want it for other reasons, including private cover for obstetrics/ birth, or to reduce the amount paid at tax time (everyone pays a Medicare levy to the government at tax time, but if you earn over a certain level and DON'T have PHI, then you pay an enhanced levy. The enhanced levy can be more than you would pay in PHI premiums).
    It's almost unheard of to have PHI paid by your employer in Australia. You may get a discounted rate, or access to a special, better value fund for specific industries, but that's about it.

  6. #5
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    Quote Originally Posted by SJ565 View Post
    Egg pick up is same as egg retrieval.
    For IVF, it's not really worth getting private health insurance (PHI). You'll pay a lot more in premiums than you would get back.
    But you may want it for other reasons, including private cover for obstetrics/ birth, or to reduce the amount paid at tax time (everyone pays a Medicare levy to the government at tax time, but if you earn over a certain level and DON'T have PHI, then you pay an enhanced levy. The enhanced levy can be more than you would pay in PHI premiums).
    It's almost unheard of to have PHI paid by your employer in Australia. You may get a discounted rate, or access to a special, better value fund for specific industries, but that's about it.
    I think you’ve pretty much explained it all wonderfully. Thanks so much.

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    Just to add, if you want to choose your obstetrician and birth at a private hospital, you’ll need private health insurance. Most have a 12 month waiting period so you’ll need maternity cover 12 months before giving birth. The insurance covers your hospital and obstetrician fees during the birth. Private health does not cover the fees when you visit the obstetrician’s rooms for appointments but you get some money back from Medicare.

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    2ybabes (11-05-2019)


 

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