Small Win – Medicare Rebates for ICSI

When I started working on this campaign I did quite a lot of research on the Medicare Rebates relating to IVF and surrogacy. During my research I noted that the Health Insurance (General Medical Services Table) Regulations 2011 excluded Medicare rebates for item numbers 13200-13221. In the Medicare Benefits Schedule these item numbers related to various IVF procedures.

What I also noticed that ICSI (the process of inserting the sperm directly into the egg) was item number 13251. As you can see not one of the item numbers excluded from the Medicare rebates. So I asked my fertility clinic if I could receive a receipt so I could claim my rebate. They denied me.

So I rang and wrote to Medicare asking for assistance. They initially advised that all IVF treatments used for surrogacy were excluded from the rebate. I pointed out to them that this is not what the law says. So they referred my concerns to the Department of Health and Aging.

I am pleased to say, that today I have received written advice from the Department saying that my understanding of the law is correct and that I am entitled to a rebate for ICSI.

If anyone else used ICSI for their embryo creation, I’d encourage you to ask your clinic to bill you separately for this treatment so you can claim your rebate from Medicare. If you have any issues I’d encourage you to print out this letter and show your clinic, or when you ring Medicare.

This is a great small win for us!

It also poses more questions. Why are all other IVF treatments excluded for Medicare rebates but this one is not? I think this just adds to our argument that we should be receiving the full rebates.

Don’t give up everyone, I feel a change just around the corner. 🙂

Letter from Dept Health & Aging

Response from Department of Health & Ageing

Today we received a promising response from the Department of Health and Ageing.

Firstly they “commended” us for the work we are doing to create awareness about the Medicare laws as they relate to surrogacy.

Secondly they reiterated that they are committed to medically necessary services to the public and are therefore actively considering the issues raised in the surrogacy paper. They have advised that I am welcome to contact them to see how this work is progressing and provided the contact Ms Mary Warner, Director of Medical Services.

I am so proud of this response and hope that they are sincere in their response.

Please continue the great work you are all doing in creating awareness about this issue, great joint effort.

Letter from Dept Health & Aging

Tracy’s Story

Let me just start this by saying that in no way does my story compare to the heartache that others in this blog have been through. My husband and I have been blessed with a gorgeous little boy. However, the current Medicare legislations are certainly putting an extra hurdle in the way of completing our family.

Tracy with her husband John and precious son Oliver

Tracy with her husband John and precious son Oliver

John and I met and married within a year and a half. We were in our early thirties and just knew it was right. We both had stable jobs, I was a primary school teacher and John was an engineer. We had the car, the house, the Labrador. The next thing to conquer was the kids! We were so excited to start a family together and hoped to have three children. I come from a small family and John’s family are all in Ireland so it was our plan to bring back the noisy house and big Christmases that I’d dreamed of. We fell pregnant very quickly. At our 10 week scan, we found that the heartbeat had stopped. We were devastated. But four months later, we found that we were pregnant again. I was anxious, but as the weeks rolled on I got more and more confident that this pregnancy was going to work. I was healthy throughout and we got busy preparing for our new addition. Oliver was born after a drug free natural labour on the 5th of November 2012. As the doctor placed him on my chest, I began to feel strange. I don’t remember much after that… Apparently, my uterus inverted causing a severe post partum haemorrhage. I required 13 units of blood in a transfusion and my blood pressure was so low that they were expecting brain damage or cardiac arrest! The only way to save my life was an emergency hysterectomy. My poor husband saw all this unfold and had to give the consent to perform the operation, something he’ll never come to terms with.

I remember waking up in the ICU after being on life support for a couple of days. I was so relieved to hear that my son was fine but was absolutely heartbroken to hear that I would not be able to carry any more children. I just sobbed and sobbed and sobbed. I had never felt emotional pain like that before.

Tracy's wishes she could give her son Oliver a sibling

Tracy’s wishes she could give her son Oliver a sibling

Anyway, fast forward almost 4 months and I love being a mummy. I’m on maternity leave and enjoying every minute of it. Physically I have healed, however, I’m not ready to give up the dream of more children. I’ve looked into adoption and permanent care, however, there are so few children to be placed that our chances aren’t high. During my research I have found that finding a gestational carrier can happen to everyday families like us! At this stage, I’m unsure if this will occur in Australia or overseas. This is completely dependent on whether I can find a carrier here or not, but either way, I will be doing my IVF cycle on home soil. We have discussed the priorities for our family and have decided that another child is more important to us than a new car or material possessions. We will be using all of our savings to fund this and we are just hoping that the bank will allow us to take out another loan to cover the rest. If it doesn’t work the first time, I don’t think a second time will be an option. A child is our priority but if we can’t get more money, there is nothing we can do. I already feel ‘ripped off’ that I had to have a hysterectomy, but being charged extra for IVF services is like kicking us when we are down. All I can do is to hope that our actions here will persuade the powers that be to change the Medicare ruling and give us the chance to complete our family.

Holly’s Story

Holly & Ash

Holly & Ash

At age 14 i was diagnosed with a severe mullerian anomaly with a unicornuate uterus and severe endometriosis. The endometriosis drowned my fallopian tubes and one ovary. What i was left with was half a uterus, one ovary that was not connected, one kidney and no cervix. At 14 years old this was devastating. At 18 I met Ash (23), he was beautifiul, kind and supportive. Like any normal couple our age we had a normal lifestyle, normal paying jobs and a house loan but there was just one thing missing, a child. 6 operations later the news I received was heart breaking ” I’m so sorry Holly, there is nothing more we can do” Surrogacy was our only option. I spent months resaeaching how to go about it and what to do. My gorgeous mum was the first person to offer, it was like a dream come true. Sadly Mum was diagnosed with hormone related cancer and was no longer able to carry our baby. Six months later a wonderful woman offered to carry my baby. The words estatic and overjoyed don’t even come close to what we were feeling! However those feeling didn’t last long when we were told that medicare wouldn’t cover us for IVF. We are looking at around $15,000 – $20,000. As a normal young couple this just seemed out of reach. Medicare cover everyone else for IVF but will not cover us. Not only do we have $15-20,000 for IVF but we also have another $20,000 + for other surrogacy involved costs. It is my understanding that when Medicare made this decision surrogacy was illegal, now that surrogace IS legal here in Australia the outdated laws need to change. So over all i feel discriminated against and think this is greatly unfair. Please change the law so that us and couples like us can be blessed with a family

The Complicated Surrogacy Process – step by step

Given we have so many supporters not familiar with surrogacy, we thought it might be worth while writing a post about the process. Surrogacy is a complicated process and an expensive one at that. So we thought you should know what we go through in order to have our babies.

Before I start here are some common surrogacy terms explained:

· Intending Parents (IPs): Couples looking for a surrogate or who have a surrogate
· Intending Mother (IM): The mother looking for a surrogate or who has a surrogate
· Intending Father (IF): The father looking for a surrogate or who has a surrogate
· Gestational Surrogate (GS): A surrogate who has no biological link to the baby she carries. Either the IPs sperm and eggs are used to make the embryo, donor eggs and sperm or a combination of both.
· Traditional Surrogate (TS): The surrogate uses her own egg but the Ifs sperm or donor sperm.

For surrogacy to be legal in australia it must be altruistic, meaning the surrogate must not be paid for carrying the baby except for her reasonable expenses.

Given this, the biggest hurdle for a couple requiring a surrogate is to find one! It is illegal for a couple to advertise for a surrogate and it is illegal for a surrogate to advertise their services. This makes it very difficult for IPs to find surrogates. A lot of surrogates are IPs sisters, female friends, even their mothers. But for IPs, like us, who don’t have this option, they have to rely on the kindness of strangers.

So how do you find a surrogate? Well thank god for the modern technology, the internet! There are several websites designed for IPs looking for a surrogate and surrogates looking for IPs to meet up. IPs and surrogates need to be careful what they write though as remember its illegal to advertise or make comments designed to encourage surrogates to come forward.
So many IPs post their stories and wait and hope that privately a surrogate will contact them. And that’s basically it. So as you can imagine this is a very difficult process and can take months, even years.

The law states that a surrogate must be over 25 years of age and have had at least one child – although it does say there may be exceptions – whatever they may be.

The law also says a couple must have a medical reason for requiring a surrogate. So contrary to popular belief, surrogacy is not used because the woman is too busy to be pregnant or too vain.

The law also requires IPs and the surrogate and the surrogate’s partner to attend counselling. The counsellor is required to ensure both couples fully understand the process and the issues that may arise during the process. The counsellor must then write a report saying they are comfortable that both couples understand the process.

Both couples are then required to obtain legal advice. This legal advice must include any issues that may arise out of the process. It also ensures both couples understand that the surrogate and the surrogates partner are legally the baby’s parents. This means that it is completely up to the surrogate to give up the child to the IPs. Basically if the surrogate decides to keep the child there is not a lot the IPs can do except to start a legal case.

But on the other hand, there is also the possibility that the IPs can change their mind and decide not to take the child. So the legal advice covers all this sort of stuff – ensures everyone knows of what could go wrong.

Once the legal advice is obtained an agreement must be drawn up between the couples. The law does not state what must be in this agreement – which is a strange thing. The only thing the law does say is that the agreement is not enforceable. Weird right? What’s the point of it then? Well who knows really? But I guess it is a good opportunity for both couples to put down in writing what they expect from the process.

Probably the main thing that’s in most agreements is what costs the IPs will cover. Whilst it is illegal for the IPs to pay the surrogate, the law states that the IPs must pay all reasonable expenses incurred by the surrogate. So reasonable expenses might include – legal and counselling fees, medical fees, parking, petrol, life insurance, death insurance, health insurance, maternity clothes, drugs, loss of wages, required child care etc etc. Basically anything the surrogate might have to pay for to get pregnant or whilst pregnant or recovering from giving birth the IPs must pay for. But what is deemed reasonable to one surrogate and IPs might be different to others.

Once all this is taken care of the IVF process starts. The IVF process is the same as any other IVF process, they take the IMs eggs (or donor eggs), take the IFs sperm (or donor sperm), put the two together and then hopefully create some embryos. One (or two in some cases) embryo is then transferred to the surrogate who will hopefully get pregnant. As you are aware Medicare does not assist in any of the costs related to the IVF process.

Of course the IVF process could take one go or it could take multiple times.

Once the surrogate is pregnant Medicare and the health funds come to the party. A surrogate is considered as any other pregnant woman. Basically it is not recognised as a surrogacy. Given this the surrogate has full control over the pregnancy and makes all decisions relating to the prenatal care. Generally though the surrogate and IPs work together on the process.
Once the surrogate has the baby, the surrogate will hopefully hand over the baby to the IPs. The IPs then must wait 28 days but no more than 6 months to apply for a parentage order. This basically changes the legal parents from the surrogate and her partner to the IPs. The birth certificate is changed to reflect this change. Both parties must consent to the parentage orders.

Prior to the parentage orders being granted, both couples must attend more counselling. The counsellor must ensure that both parties are ok with the process and the granting of the parentage orders are in the best interest of the child. And yep another report needs to be drawn up.

And that’s the end of the process! As you can see it is a long and stressful process for all involved.

Of course I have only just touched on the mechanics of it. Between all the steps a lot of bonding occurs between the surrogate, her partner and the IPs. I have not attempted to touch on the emotional part of it.

Anyway I hope this explains the process for everyone. Please feel free to ask me questions and for those experienced in the process, if I have missed anything let me know and I will update.

Janelle’s Story

In 2008 my husband and I experienced the heartache of miscarriage. My doctor told me that it was most likely due to fibroids and that I needed to consider surgery. We tried to fall pregnant again over the next 12 months without success. As it was, I didn’t know how I would handle a second miscarriage anyway so in 2009 I had the surgery to remove the fibroids but there were too many. My doctor told me he stopped counting after 100 and then had to stop removing them altogether as it would risk the viability of my uterus. Even after the surgery, there were still so many tiny fibroids that the walls of my uterus looked like rice bubbles. Since 2009 we have undergone more treatment to shrink the fibroids and six IVF cycles. Along the way, we have been able to create some beautiful little embyros but the bottom line is that I just don’t have a good enough uterus to keep them in.

After our last IVF cycle, my husband and I sat down and discussed our options. We considered stopping altogether and not having a family, but neither of us were willing to go that way. And so the other option was surrogacy. We weighed up the financial cost and what it is going to mean for us. At the end of the day we decided that the chance of having a beautiful baby in our arms was worth it and we couldn’t give up before we had tried everything. But the financial impact of surrogacy will affect us for the rest of our lives. It will mean that I will have to go back to work a lot sooner after the birth than I otherwise would want to. It means we won’t be able to afford to buy a home in the next few years. It means our baby won’t have everything we would like to give them, but they will have a loving, dedicated mother and father who want that child in their lives more than anything else in the world.

I am so blessed that surrogacy is an option for us and that we have a wonderful surrogate who I cannot thank enough. But it’s not an easy option. I’ve grieved the loss of not being able to carry a baby myself and we have had to make some serious financial decisions. But by removing the discrimination in the Medicare Legislation, my husband and I will be able to start our long hoped for family, like so many other Australians, without the additional crushing expense. It won’t lessen the emotional impact of not being able to carry your own child but it will mean that the child is born into a family not burdened with added debt, over and above the usual cost of bring a new life into the world.

Tracy’s Story

Our story is a little different than most involved in this process in that we are lucky enough to have 3 amazing sons from my previous marriage.

I was advised 5 years ago that due to medical reasons it was best if I had a hysterectomy. It was a very upsetting time full of confusion, disappointment and feelings of failure. I thought I would no longer be a real woman but held tight to the knowledge that I had my 3 beautiful boys and my life was full and my family complete, or so I thought.

I always wondered if I would meet another man that I would love and have a life and future with. I worried that if not being able to have children would be an issue and how could any man love me regardless. As such I decided not to look, that it would be best not to put myself through disappointment and heartache again, that I could be happy being on my own and I was luckier than some so be grateful for what I had.

So going along in my own little world one day I happen to run into a guy at my friends place. She introduced us for about 5 minutes and that was that. He could not stop texting our friend to organise a BBQ that night so he could see me, she did and we have been together ever since.

Tracy and her partner

Tracy and her partner

This man turned my world upside down, the love and affection in his big heart, the care and compassion he has for everyone is amazing. We talked about children and I had told him the first night about my situation, he had always wanted children and thought he could live without them as long as we were together. After seeing him with his nieces and god daughters my heart started to break as I told myself how could I do this to such a beautiful soul, how could I ask him to give up his dream of a child when I was so fortunate to have been though the experience of 3 beautiful babies. More than anything I wanted to share this beautiful experience with this man that loved me so much, this man that I had given my heart to and could never image living without. I wanted a baby with this man and I wanted to make our family complete.

One night at our friends she raised the issue of children, when I told her my situation she burst out saying well I’ll carry it. We were stunned, what and how could this be done. She continued to tell us that she had donated eggs to her cousin for IVF the year before and pulled out a book all about it. My partner and I said we would talk about and it was something we could look at later on. Our friend kept raising the possibility with each of us together and singly, we would casually discuss this at night whilst cuddle up and thought this could be a possibility as it would allow us to forfill our dream of completing our family.

I raised it with our older boys who light up with excitement and of course suggested a little sister would be a good idea. One afternoon on the train on my way home from work my partner called me, he is a long haul driver in the transport industry and calls me numerous times a day just to say hello and he misses me. He was away on a trip and called to see how my day was, I advised him that our friend had raised the issue about a baby the other day and he responded with ‘well what do you think’? Being a true female I said ‘well what do you think’? His reply floored me, he said ‘I think we should just go for it’ I asked if this meant he wanted me to start looking into the whole surrogacy think and he said ‘yes’. We were going to have a baby, or at least give it everything we had to make it happen. I was so excited and jubilant I almost squealed with joy but then remembered I was in the quite carriage and did a little wiggle instead.

Well I started to look into the whole surrogacy thing, the first thing I found was OMG there is not much out there that is useful and everything contradicts itself, the legislation and law is one thing but what and how this occurs is another. Then I stumbled across Hub Bub and that was it, I found so much information and so many wonderful people who really care and want to help. I am not alone, there are others out there and I found them.

I soon had a lot of info and started looking into clinics to try and get a price which is when I was advised that it is approx. $15,000-$18,000 and 100% out of pocket as Medicare does not rebate AT ALL. I then started looking into the legal side and costs and was advised that it is approx. $15,000-$18,000 and is NOT legally enforceable and that after all the stress, heartache and expense the GS could still say she is keeping the baby and there is nothing the law or us can do about it.

Well we are very lucky that our GC is a very close friend who has always and will always be in our lives and we will have no issue with the hand over. We do have issues with the costs of everything.

Due to my age 44 and turning 45 this year and the excessive costs of everything, this is it for us. We will only have one chance and that is more upsetting than anything. Medicare and this government have made it impossible for us (as is with many others I am sure) to go through this process again in the current situation.