General Medical issues thread

[Pushka]

I don't think I'm eligible @Quickstatus.

Apparently I earn a lot but no one considers the amount owed.

It’s spend on medical costs I think and not income based. But requires a spend of over $2500 on gaps.

 

[Quickstatus]

Apparently I earn a lot

There is no income threshold for Medicare Safety Net or Extended Medicare safety net.....
OMSN threshold = if you/family exceed $560.40 paid per year due to the difference between the medicare rebate and the medicare schedule fee medicare will automatically pay 100% of schedule fee for subsequent claims
EMSN threshold = if you/family exceed $2544.30 paid per year over the schedule fee, then medicare will refund 80% of subsequent gaps

concessional card holder thresholds are lower.

 

[RooFlyer]

Medicare safety net is $2,544 of out-of-pockets, as @Pushka noted. You need to register for it. Your current 'spend' towards it is shown on the Medicare app. There is a family safety net too.

There is also a pharmaceutical safety net, where you get reduced charges (beyond PBS) after reaching a certain amount in a calendar year - about $1650 or $280 for concession card holders. Medicines then free for concession card holders, $7.70 for others.

But the amount is at one pharmac_, not total spend. I only discovered it when my pharmac_ told me I had reached the limit a few years ago. A threshold I didn't like reaching. I enquired yesterday and still some way to go, this year

PBS Safety Net thresholds - Pharmaceutical Benefits Scheme - Services Australia

Once you or your family spend a certain amount on PBS medicine you’ll reach the PBS Safety Net threshold.

www.servicesaustralia.gov.au

 

[Pushka]

Medicare safety net is $2,544 of out-of-pockets, as @Pushka noted. You need to register for it. Your current 'spend' towards it is shown on the Medicare app. There is a family safety net too.

There is also a pharmaceutical safety net, where you get reduced charges (beyond PBS) after reaching a certain amount in a calendar year - about $1650 or $280 for concession card holders. Free for concession card holders, $7.70 for others.

But the amount is at one pharmac_, not total spend. I only discovered it when my pharmac_ told me I had reached the limit a few years ago. A threshold I didn't like reaching. I enquired yesterday and still some way to go, this year

PBS Safety Net thresholds - Pharmaceutical Benefits Scheme - Services Australia

Once you or your family spend a certain amount on PBS medicine you’ll reach the PBS Safety Net threshold.

www.servicesaustralia.gov.au

One pharmac_! I never knew. I’d go close. But - not at one. Next year……

 

[RooFlyer]

One pharmac_! I never knew. I’d go close. But - not at one. Next year……

That's what they told me at my pharmac_ . A good way to get repeat business, but I think its right.

EDIT: Hmmm ... reading more, that doesn't seem to be the case. But otherwise you have to keep track yourself. AT one pharmac_, they just look it up.

Keep track of your PBS medicines - Pharmaceutical Benefits Scheme - Services Australia

Keep track of your PBS medicines so you know when you’ve reached the PBS Safety Net threshold.

www.servicesaustralia.gov.au

Its not necessarily good when you go in and all the pharmacists know you by name ...

 

[Quickstatus]

There is also a pharmaceutical safety net

I wonder if the recent changes to pharmac_ dispensing (of more than a month at a time) will result in less people hitting the PBS safety net threshold.

 

[RooFlyer]

I wonder if the recent changes to pharmac_ dispensing (of more than a month at a time) will result in less people hitting the PBS safety net threshold.

I don't think by much. The range of medicines covered by the 2 month thing is pretty limited and you only save the dispensing fee of one, I think?

 

[Pushka]

I wonder if the recent changes to pharmac_ dispensing (of more than a month at a time) will result in less people hitting the PBS safety net threshold.

You still pay for two lots of the medication though. It’s just the $2 dispensing fee isn’t charged for both.

This was such a non announcement. Only saves me $2 for one of my scripts and the other five aren’t covered so still require the same number of GP visits and the same number of trips to the pharmac_ for the rest of them.

But worse is that one script only has one repeat allowed so have to keep making appointments for that. It’s only hydroxychloroquine so not a dangerous drug at all. The rheumatologist just doesn’t understand why it’s like this.

 

[prozac]

That's what they told me at my pharmac_ . A good way to get repeat business, but I think its right.

EDIT: Hmmm ... reading more, that doesn't seem to be the case. But otherwise you have to keep track yourself. AT one pharmac_, they just look it up.

Keep track of your PBS medicines - Pharmaceutical Benefits Scheme - Services Australia

Keep track of your PBS medicines so you know when you’ve reached the PBS Safety Net threshold.

www.servicesaustralia.gov.au

Its not necessarily good when you go in and all the pharmacists know you by name ...

It seems you need to keep track of spend yourself. Keep track of your PBS medicines - Pharmaceutical Benefits Scheme - Services Australia

EDIT: I see @RooFlyer you have come to the same conclusion.

Just had a look through my medicare history. What an eye opener. The number of doctors involved in my treatment I never met, or don't recall. Just the shear volume of claims is astounding ...

 

[tgh]

We always hit the safety net and usually early in the year

 

[Quickstatus]

Just the shear volume of claims is astounding ...

There is one fellow that has been in the Private hospital now for 9 months. He is getting multiple letters informing him of claims even though the vast majority if no all are "No gap". It is very inefficient.

 

[lakeman]

But worse is that one script only has one repeat allowed so have to keep making appointments for that. It’s only hydroxychloroquine so not a dangerous drug at all. The rheumatologist just doesn’t understand why it’s like this.

I think it’s a hangover from when it was touted as a Covid treatment.
It can cause eye issues hence the eye checks.

 

[prozac]

There is one fellow that has been in the Private hospital now for 9 months. He is getting multiple letters informing him of claims even though the vast majority if no all are "No gap". It is very inefficient.

I only had one issue with a payment from my stay in hospital. Lumis imaging kept sending me demands for an in-hospital procedure. I ended up on the Product review site and the number of people in a similar position was large. Lodging a complaint with the hospital was the only way I could get them to respond to the mistake. They need a PR overhaul, Lumis, not the hospital.

 

[Pushka]

I think it’s a hangover from when it was touted as a Covid treatment.
It can cause eye issues hence the eye checks.

It's always been a two script thing even before Covid. Yes, it can cause eye issues but rheumatologists are on top of the side effects so it's weird that they can't prescribe it for longer. steroi_s cause much more harm but there's pretty much a free licence to prescribe.

 

[Quickstatus]

I think it’s a hangover from when it was touted as a Covid treatment.

IIRC when the amount of prescriptions for HCQ exploded in the early Rona period, the prescription rules changed from unrestricted to authority only because of the massive "off label" prescribing potentially causing shortages for people who really need it - for autoimmune conditions or malaria
The authority only requirement has now been removed since 2022 for continuing treatment but not for initiation of treatment. GPs cannot initiate HCQ treatment - has to be authorised by certain specialists.

The eye issue is quite rare but yes they need regular eye checkups.

The one repeat has always been there IIRC. 100 pills + 1 repeat should be enough for 6 months unless of curse if you are taking 2/day

 

[MARTINE]

It seems you need to keep track of spend yourself. Keep track of your PBS medicines - Pharmaceutical Benefits Scheme - Services Australia

EDIT: I see @RooFlyer you have come to the same conclusion.

Just had a look through my medicare history. What an eye opener. The number of doctors involved in my treatment I never met, or don't recall. Just the shear volume of claims is astounding ...

Re: the last item, investigations (eg blood tests/biopsy) will have the name of the pathologist who did test/reviewed etc — and it will be unlikely you would know who they are.
If that helps
Hope your recovery progressing well

 

[Pushka]

IIRC when the amount of prescriptions for HCQ exploded in the early Rona period, the prescription rules changed from unrestricted to authority only because of the massive "off label" prescribing potentially causing shortages for people who really need it - for autoimmune conditions or malaria
The authority only requirement has now been removed since 2022 for continuing treatment but not for initiation of treatment. GPs cannot initiate HCQ treatment - has to be authorised by certain specialists.

The eye issue is quite rare but yes they need regular eye checkups.

The one repeat has always been there IIRC. 100 pills + 1 repeat should be enough for 6 months unless of curse if you are taking 2/day

My GP can prescribe it as I was taking HCQ before Covid. It was very hard to source during that time. The usual dose however, is two a day. So just fifty days for me so requires more visits than any other script.

Pre Covid only Specialists could prescribe it through PBS but it could be prescribed by Doctors privately and that's where the 'damage' was done on supply.

 

[JohnK]

Just on the topic of cost/safety nets @JohnK . There is the Medicare safety net. Are you eligible?

Queensland Radiology has mentioned CTPA is generally bulk billed but would need to see referral before confirming.

No sedation. But the CT is a doughnut and body goes in legs first but the head does not go into doughnut. The CT would be a minimum of 20 minutes. (I don't have Valium and my Xanax is very low strength so not same effect)

Qscan is also saying bulk billed and they treat a CTPA as urgent so they open up availability same day.

 

[Quickstatus]

Qscan is also saying bulk billed and they treat a CTPA as urgent

That is correct
Just need a referral from GP stating: "raised D dimer + cough ?? pulmonary embolus"

Yes as @drron said its a doughnut your head is still outside for CTPA. You will need to hold your breath for short periods at various times so being awake is the best. Often sedated patients don't obey commands and that can be problematic. Any sedation will need to be light.

Someone mentioned using some headphones blue toothed to your phone listening to music if that helps.

 

[RooFlyer]

Someone mentioned using some headphones blue toothed to your phone listening to music if that helps.

When I went for my extended (forecast 45 mins) MRI, they asked what music I'd like (their headphones). I didn't pay much attention but said my favourite 'Glenn Miller' . I laughed when GM's 'In the mood' came through the headphones. A very extensive music library for an imaging place.