A revised version of the Spring Newsletter can be accessed here and this information supersedes some previous advice regarding NIB benefits.
In the original published Spring 2015 Newsletter information was provided regarding the amounts that the private insurer, NIB, will rebate to their policy holders for eye injections performed in a private hospital/day case setting.
The Foundation would like to clarify information relating to this original article.
The original article stated that NIB had ceased providing benefits for 224 items, including 3 items for eye injections.
Private health insurer NIB has ceased providing MediGap benefits for 224 items including 3 items for eye injections undertaken in a private hospital or day surgery setting effective 17 August 2015.
NIB will in fact continue to reimburse $75.15 for an eye injection (item 42738, 42739 or 42740), being the gap between the schedule fee ($300.75) and the Medicare reimbursement for hospital treatment ($225.60). NIB will no longer provide any additional reimbursement for these items if the doctor's injection fee is above the schedule fee.
The choice between the provision of injections in theatre or in rooms is between the doctor and the patient. However, if NIB customers decide to continue treatment in theatre they will now incur out-of pocket expenses if the doctor charges above the schedule fee for an eye injection.
Note that private health insurance (from any insurer) does not cover gap payments for procedures performed in ophthalmologists’ rooms.
The Foundation remains concerned that NIB has significantly reduced the benefits paid, and calls on NIB to reinstate the original level of coverage. We will continue to monitor the policies of all private health insurers and liaise with relevant government agencies about these issues where appropriate.
21 September 2015