Fertility Clinic Fees Worked Example

Below is a worked example of an initial IVF program resulting in an oocyte retrieval and embryo transfer with embryo freezing.  The fees are indicative only and each fertility clinic will have its own fee structure.  Also note that the Medicare rebates and values were correct at 1 January 2018, and may be changed throughout each calendar year.  Note that the values change frequently and to see the current Medicare fees, benefits other values please click on the following link: http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Home 

The worked example is for IVF only and does not specifically include embryo cryopreservation of excess embryos (see Fees>Service Providers 9. Laboratory Services).  The example shows the initial and subsequent cycles.  The initial cycle is the first cycle of treatment by the patient for IVF in any calendar year. Fee billing and Medicare rebates reset at the start of a calendar year.   Subsequent cycles are any IVF treatment cycles that follow in that year and refer only to fresh egg pickup cycles (IVF cycles).  Note that Frozen Embryo Transfer cycles (FET)  are not considered to be subsequent IVF cycles.

The big question is why is there an initial cycle and why a subsequent cycle?  It is unlikely that anyone outside Human Services could adequately answer this question.  The key consequence for patients is that the out of pocket (OOP) for a subsequent cycle is much less, $2,246.10 versus $2,802.05 and this is primarily because the EMSN cap is much higher:  $1,675.50 versus $2,432.15.  As shown in this example, the maximum EMSN rebate for a subsequent cycle is $756 more than for an initial cycle which more than offsets the reduced Medicare rebate.

What does this mean?  Medical considerations aside, from a purely financial perspective, patients should aim to commence IVF treatment early in each calendar year.  If that cycle fails then a second attempt can be made later in the year taking advantage of the increased rebate for the subsequent cycle.  If a first cycle is undertaken later in the year and the cycle is not successful, then a later IVF treatment cycle may be pushed to the next calendar year, so financially this would be considered two initial cycles.

MORE INFORMATION ON THE WORKED EXAMPLE

The worked example is just that, an example.  It shows the fundamentals of the billing system and each clinic may present their account differently.  Most clinics now require upfront payment of fees either all at once or in two or more tranches.  Most will also give patients written information on the fees charged.  Can this information be trusted?  For the most part it can be trusted, but this is a complex process and it often involves more than one provider as described in detail in the Fees>Service Providers section and this is where confusion is most likely to occur.