Medicare Information

Fertility First  >  Medicare Information

We hope this information will answer your questions about the charges at Fertility First for your consultation and treatment. For further clarification please contact us on (02)9586 3311.


Why do we need a referral?

In order to claim from Medicare you must have a current referral. If you haven’t arranged a referral you will not be able to make a claim from Medicare towards the cost of your consultation or treatment and your “out-of-pocket” expenses will be much greater.  It is illegal for your doctor to backdate a referral. 


What are the different types of fees?

1. Medicare Schedule Fee

This is the fee for a medical service set by the Australian Government and is the basis for the Medicare rebate. Unfortunately this fee has not kept pace with changing costs, as measured by the CPI (consumer price index), advances in technology, insurance and medical indemnity increases. Therefore many medical practitioners do not accept these fees as sufficient remuneration for services. Fertility First charges the schedule fee where possible.


2. Medicare Rebate

This is the proportion of the fee paid by Medicare on your behalf. This rebate is normally 85% of the schedule fee for outpatient services and 75% of the schedule fee for inpatient services.

3. Gap

This is the difference between the Medicare schedule fee (the fee for the service set by the Australian Government) and the Medicare rebate (the actual amount you are refunded by the Australian Government). Fertility First usually only bills the Medicare rebate for treatment costs but a gap will apply for work, technology and medications not covered within the Medicare fee system.

4. ‘Out of Pocket Expenses’


Your private health fund covers the “gap” between the Medicare rebate and schedule fee only if you are a hospital inpatient. Therefore, any outpatient “gaps” are not covered by private health insurance. All fertility treatments, such as IUI and IVF, have been classified as outpatient services by the Medicare system and therefore the “gap” can not be covered by private health insurance.

5. Global Fee

This is a Medicare schedule fee for a cycle of treatment, such as intrauterine insemination (IUI) or IVF. It covers all blood tests, ultrasound scans, medical, nursing, and counselling services from the first day of the treatment cycle and continues for a period of not more than 30 days.  There is currently no restriction on the number of treatment cycles a woman can have in her lifetime.

IMPORTANT: No Medicare rebate is available if you attend an outside practitioner, rather than Fertility First, for injections or additional services related to your treatment during the period of the Global fee. If you seek your general practitioner’s advice for a medical problem which is not related to your cycle of treatment eg. a cold or a sore throat, then Medicare will pay the usual 85% of the schedule fee but your doctor must mark the account “NOT FERTILITY”.  This only applies while you are undergoing a cycle of treatment.

6. Medicare Safety Net

Unfortunately Medicare rebates for outpatient medical treatments have not kept pace with the increase in technology and insurance costs or the consumer price index (CPI) on which wages are set so medical treatment costs are rising. As a result the Medicare Safety net was established by the Australian Government. The aim is reduce your ‘out-of-pocket’ costs’ when the total of your gap payments rise above a certain threshold. To be eligible you need to register for the Medicare Safety Net, which can be done online at www.medicare.gov.au/ . It is critical to register all family members to maximise your rebate. More information on the programme can be viewed on the website or at your Medicare office.

7. Bulk Billing

This is when we accept the Medicare rebate as full payment for a particular service, ie. The 75% or 85% of the recommended fee set by Medicare for a service.  In this case there will be no “gap” or “out-of-pocket” expenses. Fertility First will transmit it directly to Medicare, so you will have no further paperwork to deal with.

8. Private Health Insurance Rebate

Some procedures require admission to hospital, eg laparoscopy or egg collection for IVF. This is referred to as an inpatient service. Private health insurance covers the difference between the Medicare rebate and the schedule fee depending upon your level of cover. The costs are for the surgery, the anaesthetist and the hospital’s fee for the use of an operating theatre, staff, equipment and the hospital bed. You should check with your private insurance fund exactly which fees are covered. In particular, you should clarify any waiting periods and “known” condition rules. Some health funds also cover the cost of some drugs used in treatment cycles. 

How much will our treatment cost?

Before starting any treatment cycle, a specific Financial Consent Form is used to reach agreement on the fees and method of payment.  The fees for some surgical treatments, treatment cycles and consultations are higher than the schedule fee, as the schedule fee has fallen behind the cost involved in providing a quality service as discussed above.  They are less than those recommended by the Australian Medical Association as being fair and reasonable. Consultations will involve “gaps” depending on whether it is a first or subsequent visit.  For surgical procedures there will be a “gap” of $400- $2000. For treatment cycles the total “gap” ranges from $250 – $3500, depending on the complexity of the technology involved.  In addition, if you do not have private health insurance, the “gap” for oocyte collection during IVF cycle is approximately $500.  There is also an account from the hospital for oocyte collection.

How can we pay our account?

Accounts can be paid using cash, cheque, EFTPOS, Electronic Transfer, credit cards or money orders.  Please direct postal payments and account queries to Fertility First.  A receipt will be issued to you in person or posted to the current address we have for you.

How do we claim from Medicare?

You will have the relevant Medicare item number on your receipt and you can claim the rebate directly from any Medicare office.  Alternatively we can submit your claim directly to Medicare electronically.  Medicare rebate cheques will be posted to you or placed into your bank account if you have provided Medicare with your account details. If you need assistance please ring Fertility First on (02)9586 3311.

Are there any other rebates we could be eligible for?

1. The Medicare Safety Net

Once “gaps” for the difference between the Medicare schedule fee and the Medicare rebate for outpatient services exceed the safety net in a calendar year, Medicare will pay additional rebates on your “out of pocket” costs. See the Medicare website www.medicare.gov.au for further information about how the Medicare Safety Net applies to you.

Are there other accounts we can expect once we start treatment?

This is unlikely unless there are non-treatment related pathology tests provided outside of the Global Fee period or tests related to completion of the initial screening investigations. The majority of these are bulk-billed unless they are for a specialised service such as genetic analysis or sperm antibodies. Additional medication not funded by the Government may be required to maximise your chance of a successful cycle. You will be advised prior to it being prescribed.

What happens if we have difficulty paying our accounts?

If you are having problems, please contact us early. Overdue accounts may result in postponement of treatment and the need to take action for debt recovery. At Fertility First we would much prefer we discussed and resolved your situation.