Friday, 29 July 2016
@bamboozled3 tweeted this snapshot on 24 July 2016 from Sue Robinson's Facebook page entry of 21 July:
The Australian Health Minister is reported as stating that we are now working through her situation in a bid to address her concerns.
A statement which does not deny that Ms. Robinson was refused this diagnostic test on the basis that she had no money to pay upfront.
News.com.au reported on 25 July 2015:
On Monday afternoon, Ms Robinson posted an update to say thank you for the support and revealed Ms Ley had made contact.
“It looks as if there might be some action on it, and that is a direct result of your response,” she wrote.
“As a result of the number of ‘shares’ and responses, the office of the Federal Health minister, Sussan Ley posted with contact details asking me to call.
“I did and was put through to a young man called Alex. We established two things. Alex assures me that the guidelines for bone scans haven’t changed since the election (I didn’t think they had, but I thought they might have since the last budget).
“He says there should have been no recent changes at all, and if I was eligible, for example, last year, I should still be eligible as I am still on the meds that compromise my bone density.
“However, according to the Medicare website I was shown this weekend my meds are on the list of those for which a bone scan is recommended, but not one for which it is reimbursed.
“There doesn’t seem to be any justification for this and it does specifically exclude cancer patients because the meds concerned are for cancer.
“I also asked Alex why are there guidelines at all? Surely if a cancer specialist regards such a test as necessary for a patient, that should be enough? After all, every case is different and the referring doctors are the only ones who can really know what is required in each case. Alex said that was a good question, but didn’t answer it, though he did tell me that these exclusions are worked out by a medical services advisory committee.
“We agreed that he would investigate further and I am sending him a link to the Medicare website so he may check the guidelines for himself.
“I also have a little more information on the charging system being used for these tests. I called other local practices who do such scans here and asked about bulk billing. They all had the same reply ... It’s complicated. It seems they can’t tell if you are eligible until you go in and then fill in a form.
“It is your answers in this form, and not the referral, which determine if you are eligible, so they say. They can’t tell you before you arrive whether or not you will be asked to pay. But if you are, the charges vary from practice to practice.
“For those of you who posted saying you are in the same boat, here are the costs you might have to pay if you are excluded from bulk billing. PRP will charge a $60 fee, Erina Radiology charges $85. Medical Imaging at Erina charges $50 for pensioners and $100 for the employed, but also states that they do whatever they can to bulk bill you. This practice was also recommended by one of my Facebook friends Maryellen Golden who said she had been bulk billed for a bone scan there herself. (Thank you Maryellen)
“I guess this isn’t unaffordable (unless you are on a limited income like a pension), and as long as you know it, you can save up. But I can’t help but wonder why it should be costed at all. I’m hoping this will be treated by the government as an unfortunate oversight that will be corrected.
And if it is, it will be your overwhelming response that brought it to their attention. Thank you again.”
For all low-income patients there are other pitfalls awaiting the unwary no matter what the diagnosis.
The Medicare website states; If you have more than one service during the same visit you may not be bulk billed for every service.
What it does not state is that the Medicare treats a patient’s claim involving multiple services differently from a claim involving a single health item and therefore the dollar amount a patient is reimbursed can be much lower.
As much as $65 lower in the instance of which I am aware, leaving the pensioner $125 out-of-pocket in total.
One of the more bizarre positions that the federal government takes is that the patient (or presumably the patient's estate if they left one) is responsible for the cost of the death certificate issued by an attending doctor - Medicare specifically includes this certificate in items not eligible for a rebate.
"Although Medicare benefits are not payable for the issue of a death certificate, an attendance on a patient at which it is determined that life is extinct can be claimed under the appropriate attendance item. The outcome of the attendance may be that a death certificate is issued, however, Medicare benefits are only payable for the attendance component of the service."
Medicare Benefits Schedules (Complete MBS and MBS by Category) operating from 1 July 2016 can be found here.