Why doesn’t Dr Sykes bulk bill for antenatal visits?

My secretaries are asked this question from time to time especially by someone who is in early pregnancy and is trying to work out which obstetrician she should book with.

Superficially, it would appear if you were bulk billed for antenatal (AN) visits you would Medicare Logopay less, but this is not the case because of your greater Medicare entitlement once you have reached the Medicare Safety Net (MSN) threshold.

YOU WOULD PAY MORE OUT OF POCKET IF YOU WERE BULK BILLED.

Bulk billing is more convenient for my staff. But, because we care about our patients, we want to maximise your Medicare entitlement and save you money, and so we don’t bulk bill antenatal visits.

An example to illustrate this

Assume that you have two antenatal visits before 20 week pregnancy and another eight after you have paid the management fee (MF) at 20 weeks, and that all your antenatal care is in the same calendar year.

Once you have paid the management fee, you have reached the Medicare Safety Net threshold. You then qualify for Medicare to reimburse you an extra capped Extended Medicare Safety Net (EMSN) payment of $32.95 for any gap payment for antenatal (AN) visits. The total Medicare will reimburse you per antenatal (AN) visit will then be $73.05. This is greater than the Medicare rebate of $41.10, which is all you get if you are bulk billed. (Medicare information was obtained from Medicare website on the 22nd July 2015.)

In the two scenarios below the overall pregnancy care fee (viz. for 10 antenatal follow-up visits plus management fee) is the same. A patient is charged exactly the same amount for pregnancy care in scenario 1 (without bulk billing of antenatal visits) as in scenario 2 (with bulk billing of antenatal visits).

Comparing Costs of Antenatal Visits

Extra out-of-pocket cost if antenatal visits are bulk billed is $263.60
$2,854.05 (scenario 2) – $2,590.45 (scenario 1) = $263.60

In the above scenarios the total amount you pay Dr Sykes for all your pregnancy care (all antenatal visits and management fee) is the same whether or not you are bulk billed for your antenatal visits. But you will have to personally pay an extra $263.60 if you are bulk billed for antenatal visits. This is because you miss out on an extra $263.60 paid to you by Medicare if you are bulk billed.

Posted by Dr Gary Sykes on - Fees

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