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TOPIC: Medicare benefits VL test confusion

Medicare benefits VL test confusion 3 years 2 months ago #16883

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In another thread I mentioned being billed for qualitative VL test where I believed I had only had 2 tests and thought I should have been covered for 4 qualitative. After collecting all my test results I found I have had 4 quantitative tests which were bulk billed (should have only had 2 bulk billable) and 2 qualitative, one of which was performed at the same time as quantitative. So I guess I'll have to suck it up and pay $155 each for SVR4 and SVR12 tests. :(
Quantitative - July 2015
Quantitative & qualitative - 10 Dec 2015
Quantitative - 15 Jan 2016 (DET <15)
Quantitative - 2 Feb 2016 (UND)
Qualitative - 8 April 2016 (SVR4)

I'm on a pension so benefit from more bulk billable items. Benefits/rebates should still apply if you're not on pension.
Ultimately the first test in July15 and qualitative on 10Dec15 were unnecessary, and 2Feb16 should have been qualitative.
Moral of the story is be careful to only have the minimum essential tests or you will have to pay.

You can check out the benefits schedule at www.health.gov.au/internet/mbsonline/pub...File/201604-Cat6.pdf Warning - confusing as hell. But it does say benefits apply for 2 quantitative and 4 qualitative as has been posted before.
M 61yo HCV+ ~ 30 yrs Gt1a F2 VL 223,000 ALT 54 AST 42 Tx start Sof/Dac 17Dec15.
SVR4 at 7Apr16 ALT 22 AST 22
SVR12 at 9Jun16 ALT 23 AST 25
Melbourne, Australia
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Medicare benefits VL test confusion 3 years 2 months ago #16885

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Hello Sonix,

The tests done in liver clinics don't count so perhaps you could get into one for your SVR12

If your pretreatment ALT was >40 and your ALT remains 1/2 or less than it was there is about 0% chance you have relapsed so bulk billed LFTs are a very useful alternative.

By July, the quantitative from July should fall off so you should have one new test to hand.
YMMV
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Medicare benefits VL test confusion 3 years 2 months ago #16886

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James-Freeman-facebook wrote:

If your pretreatment ALT was >40 and your ALT remains 1/2 or less than it was there is about 0% chance you have relapsed so bulk billed LFTs are a very useful alternative.

This is one of many comments why you are one of the best practitioners in the Hep C field.
contracted Gen 1a in the 70's, dx in 2007...ast 27 to 35...alt 43 to 96...vl 1.2 mil to 8.6 mil.
biopsy F-2 (2012)..pre tx results 1/23/16 ast 32, alt 46, vl 3.1 mil
tx started 2/11/16.... lab results 2/24/16 ast 18, alt 18, vl <15 IU/ml
28 days later.............lab results 3/9/16 ast 21, alt 21, vl UND
56 days later.............lab results 4/6/16 ast 20, alt 22, vl UND
139 days later...........lab results 6/29/16 ast 28, alt 30, vl UND...EOT
SVR24
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Medicare benefits VL test confusion 3 years 2 months ago #16887

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Thanks Dr.James. The first quantitative was at St. Vincents liver clinic while the rest were private labs. SVR12 test is due next week so guess I'll have to pay for that as there would be no chance of getting into the clinic before then.
ALT was good at SVR4 but I'd like to do SVR12 VL just for completeness.
I don't even have a path request form yet so will have to pay GP2U for that too as my GP didn't want to monitor my Tx. Funds are tight atm. :(
M 61yo HCV+ ~ 30 yrs Gt1a F2 VL 223,000 ALT 54 AST 42 Tx start Sof/Dac 17Dec15.
SVR4 at 7Apr16 ALT 22 AST 22
SVR12 at 9Jun16 ALT 23 AST 25
Melbourne, Australia
Last Edit: 3 years 2 months ago by sonix.
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Medicare benefits VL test confusion 3 years 2 months ago #16893

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The St Vincent's one does not count, so you may not be out of credits yet, in fact you should have 2 qualitative tests left, although they may have got a billing failure for a quantitative and quietly converted it to a qualitative.

As far as I know there is no lookup tool to see if you are out of qualitative/quantitative credits. What happens is that the lab tries to bulk bill it and if that fails they send you the bill.

Here are the items: www9.health.gov.au/mbs/search.cfm?q=hcv+rna&Submit=&sopt=S

I have just called Medicare on 132150 - option 1 - and according to them you have had 4 quants on May 2015, Dec 2015, Jan 2016 and Feb 2016 and NO qualitative tests. The May test has now fallen off so you have 3 official MBS tests leaving at least 1 qualitative available to be bulk billed.

PS: Sent you a form.
YMMV
Last Edit: 3 years 2 months ago by DrJames.
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Medicare benefits VL test confusion 3 years 2 months ago #16906

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Thanks a million, Dr. James!
So yeah, appears to be a bureaucratic stuffup and/or billing stuffup by the labs. Definitely had quants in Dec and Jan. I just checked your path request form for Feb and it requests qualitative but results say it was quantitative. Idiots. :S
I'm presuming the April one hasn't been presented to Medicare yet. It's the one I was billed for and I disputed it. They gave me an extra month to investigate.
I'll call Australian ClinicalLabs again and see if I can get on to a supervisor. The grunt I spoke to last time didn't seem to have a clue and said the supervisor was out.
you have 3 official MBS tests leaving at least 1 qualitative available to be bulk billed.
Are we only eligible for 4 tests total, rather than 2 quantitative plus 4 qualitative as I had previously understood?
M 61yo HCV+ ~ 30 yrs Gt1a F2 VL 223,000 ALT 54 AST 42 Tx start Sof/Dac 17Dec15.
SVR4 at 7Apr16 ALT 22 AST 22
SVR12 at 9Jun16 ALT 23 AST 25
Melbourne, Australia
Last Edit: 3 years 2 months ago by sonix.
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Medicare benefits VL test confusion 3 years 2 months ago #16925

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Last time I read the descriptors they were different to what is now there:

www9.health.gov.au/mbs/search.cfm?q=hcv+rna&Submit=&sopt=S

The older descriptors said stuff about specialist authorising, on treatment.... all of which is gone. The substantive change is that the quantitatives now seem to be counted in the 4 qualitatives, so yes it looks like it's down from 4 qual + 2 quant to 4 qual including max 2 quant.

I'm told all tests will shortly be quantitative as it's the same test process and the new machines spit out both results.
YMMV
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Medicare benefits VL test confusion 3 years 2 months ago #16932

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Thanks for explaining that, it must be why the lab want me to pay for the April one.
I don't recall having a VL in May 15 although I did have my annual(ish) LFT then. I'll have to check with my GP. At least the next one for SVR12 should be bulk billed. :)

It's those Rules 18 and 25 that are really confusing. I just looked at the MBS Schedule linked in my first post and still can't quite decipher them. :unsure:
M 61yo HCV+ ~ 30 yrs Gt1a F2 VL 223,000 ALT 54 AST 42 Tx start Sof/Dac 17Dec15.
SVR4 at 7Apr16 ALT 22 AST 22
SVR12 at 9Jun16 ALT 23 AST 25
Melbourne, Australia
Last Edit: 3 years 2 months ago by sonix.
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Medicare benefits VL test confusion 3 years 2 months ago #16945

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Hi there Sonix, Thankyou for continuing our discussion in a seperate thread.
I paid the PCR bill for $155, that was SVR4 and now awaiting the bill in the post for SVR8. I rang the lab and we will get a Medicare rebate apparently, I will see!
I had to pay over the phone by credit card so I could have my SVR8 test after all it's just one for my sanity not ordered by the hospital which I don't actually think I need to go to but will lol. They just wrote up a VL for SVR12. I have done private path since the first test at my hospital was such an old fashioned assay range that with my GP we shopped around for more exact diagnostic path.
I'm guessing that I will also pay for my SVR12 because I intend doing it outside the hospital too
Cheers from Ariel #flower
Gen 1a
Peg/inf/riba 2012(!) stop @ Wk 43 potassium low +issues (rlps week 4 post tx, VL120,000) scnds eg. adenomas.
pre sof/led VL 240,000 Fibsc F0
Day 25 <30
Day 32 UND
Week 10 UND
EOT UND ALT11AST17GGT19
SVR4 UND ALT10 AST16 GGT13
SVR8 UND ALT <9 AST16 GGT15
SVR12 UND ALT14 AST19 GGT12 Bili 5
EOT +18 ALT13 AST20 GGT9 Bili 5
EOT +21 ALT11AST15
Cured SVR12
Dysplasia Adenomas RemvdAug '16
SVR24 UND ALT11AST16
ColonoscopyClear Nov17
LumpectomyClear ‘18
LithotripsyCytoscopyBiopsy 4/18
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