Jump to content

NEWBIE PREGNANCY/IVF/HEALTH INSURANCE HELP NEEDED!


  • Please log in to reply
12 replies to this topic

#1 TazCaz

Posted 17 March 2017 - 05:18 PM

Hi everyone,

I'm new to this forum, so please let me know if this is the wrong place to start this thread.

I turn 39 next month and am still undecided about whether or not I want to have a baby. Obviously, at my age, it is a decision weighing very heavily on my mind. I know it's a huge decision to have kids - but an equally big decision NOT to have them. (And if anyone can give me any advice on making this decision, please let me know! :unsure:).

Anyway, as a first point, I am currently looking at updating my private health insurance, which currently doesn't include pregnancy/childbirth or IVF. Having talked to my current insurer, and others, they have advised I do some research on whether I feel it's important to have private cover for these things (reminding me that anything covered by private insurance is also available through the public system). I know that often you end up paying a lot more going private anyway.

As far as pregnancy is concerned - to be honest, having the same doctor the whole way through would be less important to me (I think), than simply having someone that knows what they are doing and access to all the right facilities should anything go wrong. I don't know any doctors well enough to be able to say I definitely want a particular one to be with me during my pregnancy.

As far as the IVF is concerned - well, admittedly I know less about this than the pregnancy side of things, but at 39, I need to be realistic and consider this might be something I will need. Is there a difference between IVF through the public versus private system in terms of success rate, quality of care, price etc.?

Is there anything else I need to consider when making the decision whether or not to pay extra for having pregnancy and IVF on my health insurance? Given the 12 month waiting period, it's just something I need to make the call on now.

Any help you can provide would be most appreciated.

Thank you so much in advance! :smile:

#2 Mrs_greyhound

Posted 17 March 2017 - 05:46 PM

I think, to best make your decision, you need to look at fertility clinics in your area. There are essentially three types of clinic: public, low fee private and full service private. Generally, public clinics will have a waiting list. A colleague of mine waited 14 months for IVF at RPA in Sydney. I believe that the low fee private ones will also have wait lists depending on demand.

Whatever route you go, there will be out of pocket costs. Even public clinics have fees attached. I think for you, the main factor will be age - do you want to be on a waiting list to get cheaper treatment, or would you rather start sooner? At your age, it is recommended to only try to conceive for 6 months before seeking help.

PHI won't actually save you much money on fertility treatment. It doesn't cover anything related to treatment such as OI and IUI. Medicare is what subsidises these. For a proper IVF cycle, we are OOP about 5K. That's with top level PHI. If we weren't insured, it would be about 6.5K. So not a huge difference when you consider our premium is1K a quarter!

Good luck with whatever you decide!

#3 TazCaz

Posted 17 March 2017 - 05:52 PM

Thanks for your helpful response Mrs_greyhound! I'll have to look up some of your acronyms (I am VERY new to this!) - but you make a good point about waiting lists v cost. I actually hadn't even considered there would be such lengthy waiting lists.

I'm in Melbourne at the moment, so I guess I will need to do some research about clinics here.

Do you happen to know what the rough costs are for public and low cost private are compared to the $5,000 for private?

#4 baking101

Posted 17 March 2017 - 06:20 PM

Hi there. I'm doing ICSI (a type of IVF) though a private clinic with no PHI - we have it but, like you, not for that level. I have found that it has virtually no bearing on IVF costs. The only difference is that I pay $500 per day hospital fee instead of once for the year. This is a minimal cost of IVF.

My clinic charges around $7000 OOP for a cycle and then $2000 roughly for a FET (frozen embyro transfer). You do have to pay the full amount but Medicare gets the chunk back to you pretty speedily. Bonus is you automatically go over the safety net threshold in one round so every time after that in a calendar year gets you a bit more back in your pocket.

In terms of private clinics vs public, my only experience is private and it has been highly positive in terms of care and convenience (as far as there is any when doing IVF) but I never explored public. I can see why people use it - it's a lot cheaper. I have no ideas about success rates.

If we get lucky with IVF, we will go public care for pregnancy/obstetrics. We live near an excellent public hospital and we decided that having private care is not really financially a sensible choice for us. IVF is very draining and we believe this is an area where we can economise without negative effects on me or (hopefully) bub.

Hope that helps. If you do go ahead, join us in Ready Set Go Girls. You can ask any questions you need there and have a whinge about things not going to plan.

All the best

Edited by baking101, 17 March 2017 - 06:22 PM.


#5 Wango

Posted 17 March 2017 - 08:16 PM

I had some risk factors during my pregnancy (also as the result of IVF) and had lots of extra appointments and scans.  Having the same obstetrician was invaluable and really calmed me down at a very stressful time.   Even with private health you pay a management fee which is not covered by PHI.   Mine was $2275 in adelaide and I understand that's it's easily double that or more in Sydney and Melbourne.  But not everyone has a risky pregnancy!

I had a small procedure (laparoscopy) to investigate a tumble issue prior to my first round of IVF, the one round of IVF and giving birth all in the same calendar year.  My health fund paid out over $20k for the year for me. The main thing was not having to go through waiting lists.  When I needed a laparoscopy I was booked for 1 week after the appointment with the surgeon whereas others in the public system have waited 6months or more.  

It just comes down to whether you're prepared to run the risk that you'll need these extras and potentially have to wait.

#6 Mrs_greyhound

Posted 17 March 2017 - 08:58 PM

View PostTazCaz, on 17 March 2017 - 05:52 PM, said:

Thanks for your helpful response Mrs_greyhound! I'll have to look up some of your acronyms (I am VERY new to this!) - but you make a good point about waiting lists v cost. I actually hadn't even considered there would be such lengthy waiting lists.

I'm in Melbourne at the moment, so I guess I will need to do some research about clinics here.

Do you happen to know what the rough costs are for public and low cost private are compared to the $5,000 for private?

Sorry about the acronyms.

OI = ovulation induction (either clomid or injections). That's where they give you drugs and use blood tests and scans to induce ovulation and guide you on the best time to have sex.

IUI (intrauterine inseminaton) is similar to OI, but it also involves your partner producing a semen sample which is washed and concentrated in the lab. It is then transferred to your uterus in a procedure similar to a Pap smear.

Both of these are less "invasive" than traditional IVF, but also have much lower success rates. My fertility specialist said that IUI and OI give you a 20% chance of success each month, whereas IVF has more like a 40% chance. However IVF success rates do drop pretty quickly as you approach 40.

I don't know a great detail about low cost IVF. We went straight to a big name clinic in Sydney when we were first looking into fertility assistance. Similar to Baking, we are happy where we are, and definitely won't be going elsewhere. We have done a few cycles of "standard IVF" and haven't had success and are now about to do PGS on our banked embryos. This is basically genetic testing that will tell us which of our embryos are chromosomally normal. Only about 30% of embryos created are genetically normal, which is why IVF isn't a sure fire way of getting pregnant. The PGS will basically give us more information and hopefully save time and disappointment. Techniques such as this are only available at the big clinics unfortunately. PGS doesn't even attract a Medicare rebate!

I think that IVF is kinda like flying. Economy is fine, but once you have flown business there ain't no going back!

In your situation, I would try and suss out what options are around you geographically.  I have had people argue on these boards with me that it would be worthwhile driving an hour each way to a low cost clinic. I honestly can't fathom that, when I have a fantastic clinic five minutes away. Given that you have to attend the clinic up to ten times a cycle, while juggling work and everything else, convenience for me is huge.

What you could do is put your name down early at low cost or public clinic. If you get pregnant naturally, then yay! You can cancel your appointment!

If you have no luck after 6 months, then go ahead and see a FS. Make sure your GP refers you to someone at an actual fertility clinic and not just a gynaecologist. I think I waited about 3 weeks for an initial consult. Depending on what they recommend, you could either start treatment there, or choose to wait for a cheaper clinic spot to come up.

Given your age, I suspect that they will recommend going straight to IVF and not wasting valuable time with less effective treatments.

I'm not sure what my friend paid at the public clinic, but I think it was about 2k out of pocket for an IVF cycle. She was able to get some embryos for the freezer, and was out of pocket about $500 for a frozen cycle. HOWEVER, her experience was certainly different to mine. Her morning clinic involved 2 different appointments each day. The nurses opened for blood tests at 7am, and she had to queue at 6:30. After bloods she had to go somewhere else in the hospital for a scan. The scan place opened at 8 and she often has to wait for a while. Conversely, my clinic had appointments. You could pick a time between 7 and 10am, and the nurse would do both for you in the same room. The longest I ever waited was 20 minutes. Usually in and out in 25 minutes or so. Things like that make a big difference when you then have to go to work for a full day.  

Anyway, I wish you all the best. With any luck, you will conceive naturally!

#7 Lallalla

Posted 17 March 2017 - 09:01 PM

So I don't exactly belong on this forum (unintentionally ended up here via new content), I never did IVF and I am a bit younger, but I did have a high risk pregnancy through the public system. I cannot fault the care provided. I had all the extra scans and tests etc that I needed. I even ended up with my own room after both my pregnancies (the other low risk although both resulted in a c-section). Also if your baby needs NICU care there is no such thing as going private - all NICU beds in Australia are public (or at least that is what I was told).

#8 TazCaz

Posted 19 March 2017 - 11:28 AM

Thanks for all your feedback and advice everyone!

I've been doing a bit of research and for Melbourne, it seems Melbourne IVF and Monash (especially Dr L) are the clear favourites.

Of course, I am thinking into the future (and with any luck won't need to go down this path) - but has anyone had experience with either? I'm getting a feel for both based on what I'm reading online, but a few more opinions won't hurt.

Also, given my initial reason for - whether or not to add IVF/reproductive services/pregnancy/childbirth to my PHI - does anyone know much about cost and/or waiting lists for either of the above for if you have PHI or if you don't?

Also, any feedback on continuity of care for both would be most appreciated?

#9 ms.fred82

Posted 19 March 2017 - 11:59 AM

There can be a lot of out of pocket costs as in the private system for assisted conception or even just a private OB. On top of $4k PHI annual fees.

We did IVF last year through a well known private clinic in Sydney CBD and found they were fantastic. We could easily afford it so chose the convenience and benefit of getting started as soon as we were ready rather than trying to go public.

We have decent PHI and were out of pocket for about $12k within 6 months for a round of IVF (inc fresh transfer), testing of embryos and the  2 frozen transfers. PHI covered about $2k and medicare covered about $8k on top of this. From the 3 transfers, we had a miscarriage and am now pregnant with a baby due in June. We were incredibly lucky with this level of success.

I am seeing a private OB and will deliver as a private patient at RPA. Including scans, we'll probably be out of pocket about $6,500, plus any anaethetist fees needed. I like the continuity of care and having only his opinion/view rather than conflicting pieces of advice but it is comes at a pretty penny and I definitely see it as a luxury.

IVF costs add up really quickly and really PHI is pretty minimal considering the level of cover you need to pay for to get some coverage.

If you have obstretics cover, you can always choose to go public or shared GP care for your pregnancy and then use your cover to try and have a private room for your hospital stay.

#10 baking101

Posted 19 March 2017 - 12:01 PM

I don't have experience with either of those clinics but there was no difference in waiting time for me to see FS once referred by my GP.

But there would have been a 12month waiting period to add those services to PHI. We decided we didn't want to wait, and were looking at about $1200 to pay before we could access services (i.e. we would pay about $100 per month for 12 months before we would be able to access any benefits).

#11 Silverstreak

Posted 19 March 2017 - 12:51 PM

Hi OP!

i don't have advice on fertility treatment, but I am an older mum (had DS just before I turned 37) and I had him at a public hospital.

The care I received was great: I had sleep apnea and pre eclampsia, ended up having a c section after a long labour, DS was in special care for a couple of days and all the way through the care was great and I only had to pay for a couple of scans.

Also, I just wanted to add that I like being an older mum. Yes, I'm tired, but I'm also a lot more confident and relaxed than I used to be.

As for having kids, I knew that I wanted to at least give TTC a go, or I'd regret not trying. If you feel you'll regret not doing it, then give it a go! Sometimes life's most important decisions are a risk and a gamble!

Good luck with whatever you decide!

#12 TazCaz

Posted 25 March 2017 - 04:49 PM

Thank you so much everyone for taking the time to respond with very helpful advice and information.

I also spoke with one of the nurses in Monash's fertility department this week, so I have a lot of backgrounder to help make my decision.

And thank you @Silverstreak for your reassurance. I know more and more women are becoming mums later in life, but it's still a daunting prospect. I feel I still have at least a decade left before I should be considering such things, but I guess nature has other plans for us :)


#13 LUV-MY-KIDS

Posted 25 March 2017 - 07:23 PM

Having had 2 babies with pregnancy complications , 1st public and 2nd private, my second was a much better experience than the 1st.  Having my own OB with a midwife was great.  Not having to explain and re explain what was going on.  When both times I needed hospitalisation during pregnancy having my own OB was fantastic.  My OB was on holiday once when I was admitted and he coordinated my care even though he was skiing in Japan.  2nd pregnancy was just less stressful due to consistency of care and also I was in control of my care much more than public.

My 1st pregnancy when I was hospitalised during my pregnancy was highly stressful as no doctor is coordinating your care every day twice a day you have a different doctor with different opinion, it did my head in each time I ended up in hospital.

Edited by LUV-MY-KIDS, 25 March 2017 - 07:26 PM.





0 user(s) are reading this topic

0 members, 0 guests, 0 anonymous users

 
 
Advertisement
 

Top 5 Viewed Articles

 
Advertisement
 
 
 
Advertisement
 
 
Essential Baby and Essential Kids is the place to find parenting information and parenting support relating to conception, pregnancy, birth, babies, toddlers, kids, maternity, family budgeting, family travel, nutrition and wellbeing, family entertainment, kids entertainment, tips for the family home, child-friendly recipes and parenting. Try our pregnancy due date calculator to determine your due date, or our ovulation calculator to predict ovulation and your fertile period. Our pregnancy week by week guide shows your baby's stages of development. Access our very active mum's discussion groups in the Essential Baby forums or the Essential Kids forums to talk to mums about conception, pregnancy, birth, babies, toddlers, kids and parenting lifestyle. Essential Baby also offers a baby names database of more than 22,000 baby names, popular baby names, boys' names, girls' names and baby names advice in our baby names forum. Essential Kids features a range of free printable worksheets for kids from preschool years through to primary school years. For the latest baby clothes, maternity clothes, maternity accessories, toddler products, kids toys and kids clothing, breastfeeding and other parenting resources, check out Essential Baby and Essential Kids.