NON MEDICARE FEES CANBERRA FERTILITY CENTRE VERSION JANUARY 2015 AM QWB 295

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1 NON MEDICARE FEES CANBERRA FERTILITY CENTRE VERSION JANUARY 2015 AM QWB 295 1

2 CANBERRA FERTILITY CENTRE Suite 9, Level 2, Peter Yorke Building, Calvary John James Hospital, 173 Strickland Crescent, DEAKIN ACT 2600 Phone: Facsimile: Website: 2

3 Section 1 Tracking Ovulation Induction Early Pregnancy Monitoring Blood Hormone Monitoring Tests Blood tests performed by the Canberra Fertility Centre will be charged at the Medicare bulk billing rate. However, as you are not eligible for the Medicare rebate, you are required to pay for any tests at the time of service. You may be eligible for a rebate from your Private Health Insurance Fund. Please clarify this with your fund. Follicle Watch Ultrasounds Follicle watch ultrasounds performed by the Canberra Fertility Centre will be charged at the Medicare bulk billing rate. However, as you are not eligible for the Medicare rebate, you are required to pay for any ultrasounds at the time of service. You may be eligible for a rebate from your Private Health Insurance Fund. Please clarify this with your fund. Pregnancy Ultrasounds Pregnancy ultrasounds (7-8 weeks) are performed at the Canberra Fertility Centre. The fee is $ Medications If medications are needed for the above cycles your doctor will provide instructions and a prescription to be filled at a pharmacy. Progesterone pessaries (200mg each) and Crinone 8% (90mg) may be purchased from the Canberra Fertility Centre with written authorisation from your doctor. Please contact the Canberra Fertility Centre for pricing of these medications. Semen Analysis Semen Analyses are performed at the Canberra Fertility Centre and an appointment is required. Please see staff for current fee. 3

4 Section 2 Insemination AIH (Partner Insemination) Insemination AID (Donor Insemination) IVF (In Vitro Fertilisation) IVF/ICSI (Intracytoplasmic Sperm Injection) FET (Frozen Embryo Transfer) Thawed Oocyte Transfer Procedure Introduction This handout has been designed to explain the expected costs of an ART (Assisted Reproductive Technology) treatment when there is no Medicare funding available. You will need to contact your private health fund as it is your responsibility to ascertain what benefits you are eligible for. This handout assumes non-eligibility for any benefits and accounts are rendered on a full account basis. An individual patient s account is dependent upon actual treatment received and whether and complications arise during treatment. Complex treatments such as these involve the services of many different health professionals. These professionals will bill separately for their respective services and you will receive accounts from the following sources: a) Your Gynaecologist/Canberra Fertility Centre b) Your Anaesthetic Service Provider c) CAPS Clinic (Theatre) The exact nature of the account will depend on the procedure undertaken, the amount of medications used and the length of stay in hospital. Prepayment A prepayment system operates whereby the basic out-of-pocket cost of the procedure is paid before treatment commences. Please pay the amount indicated in Table 1 to the Canberra Fertility Centre before your procedure starts. All medications must be paid for on collection. Your specialist doctor or Nurse Coordinator can provide an estimate of how much medication may be required. 4

5 Table 1 PROCEDURE TYPE PREPAYMENT REQUIRED AIH/AID Stimulated $1, AIH/AID Unstimulated $1, Donor Semen Variable IVF $7, IVF/ICSI $7, FET $2, Thawed Ooctye Cycle $3, Fees from Gynaecologist/Canberra Fertility Centre Tables 2, 3 and 4 detail the expected costs from your gynaecologist/ Canberra Fertility Centre and the Medicare item numbers used in the account process. Please be aware that your account may differ depending on the extent of extra services as outlined in Table 5. Table 2 Insemination Procedures using FSH Injections (Gonal F/Puregon) ITEM NO. DESCRIPTION FEE Insemination Procedure $1, Planning & Management $ Semen Preparation $ TOTAL $1,

6 Table 3 Insemination Procedures (Unstimulated) ITEM NO. DESCRIPTION FEE Insemination Procedure $ Planning & Management $ Semen Preparation $ TOTAL $1, Table 4 IVF/ICSI Procedures ITEM NO. DESCRIPTION FEE IVF Procedure $ 6, Planning & Management $ Oocyte Retrieval $ Embryo Transfer $ ICSI (If required) $ TOTAL IVF $7, TOTAL IVF/ICSI $7, Included is provision for Synarel and Lucrin to oocyte retrieval and progesterone pessaries or Crinone to 12 days post oocyte retrieval (Day =12). 2. This item can be claimed from your private health fund. 6

7 Table 5 Frozen Embryo Transfer Procedure ITEM NO. DESCRIPTION FEE FET Procedure $1, Planning & Management $ Embryo Transfer $ TOTAL $2, Table 6 Thawed Oocyte Transfer Procedure ITEM NO. DESCRIPTION FEE FET Procedure $1, Planning & Management $ Embryo Transfer $ ICSI $ TOTAL $3, Payment of Accounts You will receive a statement from the Canberra Fertility Centre that includes the services provided by your gynaecologist during your treatment. The prepayment amount will have been deducted, and any balance owing will be shown. This account is due within 14 days. Any outstanding amount, if any, will then need to be paid to the Canberra Fertility Centre to finalise your account. If you are eligible for a private health fund rebate please submit this account. CANBERRA FERTILITY CENTRE (ACCOUNTS) PO BOX 228 CURTIN ACT Telephone:

8 OTHER EXPENSES Refer to Table 7 for details of costs. a) Medications Canberra Fertility Centre (CFC) is not a licensed pharmacy and can only dispense limited medications as noted in Section 100 of the Pharmaceutical Benefits Scheme (PBS). Your specialist may issue you a prescription medication which may not be available from CFC. In this instance you will need to source and purchase the medication from a licensed pharmacy. The nurse coordinator may be able to assist you in this process. Lucrin/Synarel/Cetrotide/Orgalutran/Progesterone Pessaries /Crinone These drugs are often required for IVF and other treatments. Synarel/Lucrin/Progesterone Pessaries and Crinone are included as part of cycle cost where indicated. Cetrotide and Orgalutran must be paid for when collecting the medication. See Table 7 for prices. b) Puregon/Gonal F/hCG injection These drugs are often required for AIH/AID/IVF and other treatments and must be paid for when collecting medication. See Table 7 for prices. c) Embryo Freezing If you obtain extra embryos and you have elected to have them stored, the fee is $ This includes the cost of initial freezing and ongoing storage for 12 months. If you wish to continue storage thereafter, there will be an annual fee of $ for which you will receive an account. This is also outlined in the Cryopreservation and Storage of Embryos consent form. This initial storage fee will be included in Item in the final account. Payment of this fee at the time of embryo transfer is recommended. 8

9 d) ICSI (Intracystoplasmic Sperm Injection) If ICSI technique is to be used, the fee associated is $ This fee forms part of the prepayment for the procedure. This fee is refunded if the technique is not used. e) Blastocyst Culture No fee attached f) Donor Semen If donor semen is needed in your treatment, the cost per straw will vary depending on where it has been sourced (i.e. overseas or locally). The cost of one donor semen straw is to be paid upon reservation of that straw. If this straw is held for more than 12 months, an annual storage fee of $ will apply. g) Assisted Hatching No fee attached h) Semen freezing If your partner is going to be unavailable during the treatment or he needs to store semen for other reasons (illness) then the cost of freezing and storage of a sperm sample is $ This includes the cost of initial freezing and ongoing storage for 12 months. If you wish to continue storage thereafter, there will be an annual fee of $ for which you will receive an account. This is also outlined in the Cryopreservation and Storage of Semen consent form. Payment for this service is required at the time the sample is provided. i) MESA/TESE collection If a surgical method is required for collection of a sperm sample at the time of oocyte retrieval then an extra fee of $ will apply. This does not include the medical or hospital fees that may apply for this procedure. Please contact your Urologist for full details. If semen is to be stored, then the freezing and storage 9

10 charges outlines in h) above, will apply. An invoice will be issued for this service. j) PESA collection If a fine needle aspiration is required for collection of a sperm sample at the time of oocyte retrieval, then a fee of $ will apply. This procedure is carried out at the Canberra Fertility Centre and an invoice will be issued. If this procedure is carried out at another facility then a fee of $ will apply for our attendance. This does not include the medical or hospital fees that may apply for this procedure. Please contact your Urologist/Surgeon for full details. If semen is to be stored, the freezing and storage charges will apply (see h above). This fee is paid at the time of freezing. 10

11 Table 7 Extra Costs ITEM DESCRIPTION COST WHEN PAID Cetrotide 250µg ampoule $87.50 At collection of medication Orgalutran 250 µg dose $77.00 At collection of medication Progesterone Pessary 200mg x 15 $75.00 At collection of medication Crinone 8% (each) $12.50 At collection of medication Synarel $ At collection of medication Lucrin $ At collection of medication Puregon Cartridge 300IU $ At collection of medication Puregon Cartridge 600IU $ At collection of medication Puregon Cartridge 900IU $ At collection of medication Gonal F Pen 300Iu $ At collection of medication Gonal F Pen 450IU $ At collection of medication Gonal F Pen 900IU $ At collection of medication Menopur 600 $ At collection of medication Menopur 1200 $ At collection of medication Pregnyl hcg 500 IU injection $14.50 At collection of medication Ovidrel 250 µg $68.00 At collection of medication ICSI $ Paid as part of prepayment Embryo Freezing (see c above) $ Included in Item on the final statement Donor semen (per straw) Variable Paid at the time of selection Semen freezing (see h above) $ At time of sample collection MESA/TESE collection $ Invoice issued PESA $ Invoice issued 11

12 Anaesthetic Service Provider Anaesthesia services are necessary for IVF and ICSI procedures and may be used in other procedures. The fees charged range from $400 - $600 plus. Please speak to the nurse coordinator to find out who your anaesthetic service provider is likely to be. If you have private health cover you may be eligible for a rebate. Contact your fund to clarify your position. Caps Clinic Canberra Fertility Centre uses the operating theatre facilities at the CAPS Clinic. IVF and IVF/ICSI oocyte (egg) collection procedures performed at the Caps Clinic will incur a fee of approximately $ If you have private health insurance you may be covered for a portion of this fee. Please check with your health fund. There is no Medicare rebate for this procedure. Caps Clinic contact Cancelled Procedures You will receive an account for cancelled insemination AIH, AID, IVF, and FET procedures. You will receive an itemised account showing the fee for the cancelled cycle, and the prepayment credited towards this account. If there is a remaining credit balance this can be held over for future treatments or you may request a refund (proof of identity required). If there is an outstanding amount on the account this is due within 14 days and needs to be paid to the Canberra Fertility Centre. (Refer to Tables 7, 8, 9 and 10 for relevant cancelled fees). 12

13 Table 8 Cancelled insemination procedures 3 ITEM NO. DESCRIPTION FEE Insemination procedure $ Planning & Management $ TOTAL $ If the insemination procedure is not carried out, the cycle is referred to as cancelled. Table 9 Cancelled FET procedures 4 ITEM NO. DESCRIPTION FEE Planning & Management $ FET Procedure $ TOTAL $ Table 10 An FET treatment cycle is considered to be cancelled if an embryo transfer does not take place Cancelled IVF/ICSI 5 ITEM NO. DESCRIPTION FEE IVF procedure $ Planning & Management $ TOTAL $ An IVF/ICSI cycle is considered cancelled if an oocyte retrieval does not take place 13

14 Section 3 Table 11: Contribution by Canberra Fertility Centre to the cost of Outside provider services for Surrogacy Procedures These contributions apply to pathology and ultrasound services associated with Assisted Reproductive Technology procedures and requested by Canberra Fertility Centre. ITEM NO. DESCRIPTION CFC CONTRIBUTIONS Follicle Watch Ultrasound $ Blood Test 1 Hormone $ Blood Test 2 Hormones $ Blood Test 3 Hormones $ Blood Test 4 Hormones $ Blood Test 5 Hormones $ Blood Test Pregnancy Hormone PEI Patient Episode Initiation Will vary depending on cycle billing type. Section 4 The fees listed in this booklet are correct at 1 January 2015 and are subject to change without notice. However, we will discuss fees with prospective patients before commencing any procedures. 14

15 NOTES 15

16

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