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Towards a fairer deal on RGP contact lenses

Disappointed by the cost of rigid gas permeable (hard) contact lenses? We are too.

Which is why we decided to stop complaining and start doing something about it. But so far with only moderate success.

What we have achieved

Since 2003, we have definitely brought the issue to the attention of the optometrists, private health funds, all of the associations working in eye health care under the auspices of Vision2020 Australia and the Federal Government.

This has been done through meetings with all of the relevant bodies, their representatives and submissions.

Coincidently, members report that rebates on rigid gas permeable lenses from some private health funds have increased dramatically over the past five years, in some cases doubling from around $60 per lens to up to $120 per lens.

But with new, complex lenses constantly coming on the market, the cost of lenses for keratoconus keeps rising. More needs to be done and innovative strategies are required to ensure that these lenses remain available to all patients who require them - not just those who can afford them.

Below are some of the key initiatives taken by Keratoconus Australia over recent years.

Since 2007, Keratoconus Australia has been working closely with Vision2020 Australia to coordinate its efforts to resolve this issue. KA attended the July 2, 2009 meeting of Vision2020 Australia's Low Vision & Rehabilitation Working Group which endorsed the Association's initiative to secure subsidized contact lenses and authorized Vision2020 to provide ongoing support to KA.

Since then, Belinda and Larry have had talks with various representatives of eye care groups in a bid to advance this issue. The most recent was a meeting in April 2010 with Vision2020 and Optometrist Association of Australia representatives which decided to examine precedents in this area to enable a new submission to be put to the Federal government after the forthcoming elections.

Vision2020 had previously supported the Association's earlier submission in May 2007 to the former Health Minister in the Howard Government, Tony Abbott (now Leader of the Opposition), outlining the failings of the current system and what needed to be done.

The reply from Ms Veronica Davidson of the department's Medical Benefits Division essentially ignored all of our arguments, indicated the existing system met our needs and concluded that patients should take out private health insurance to be reimbursed for the cost of contact lenses. Yet the basic tenet of our submission was that the private insurers had failed to recognize the special nature of contact lenses for keratoconus and reimburse patients accordingly.

We have summarized Ms Davidson’s response below. 

• Medicare does not and was never intended to provide direct assistance with the costs incurred in the purchase of optical appliances. These are a state government responsibility and each state has schemes to address the issue.

• If further funding for keratoconus is required under Medicare beyond the existing rebates for contact lens consultations, then either the Royal Australian and New Zealand College of Ophthalmologists or Optometrists Association of Australia need to apply through their respective Medicare consultative committees.

• Indirect Australian Government assistance towards the cost of optical appliances is already provided via the 30% rebate on private health insurance cover. These private health insurance policies offer ancillary cover for optical services including contact lenses – but benefits are decided by individual private health funds.

• Patients dissatisfied with the current rebates for contact lenses for keratoconus should research alternatives to find more suitable cover from another health fund.

• Further indirect assistance is provided via the Australia Government’s Net Medical Expenses Tax Offset scheme administered by the Australian Tax Office. Under that scheme, taxpayers can claim medical expenses over $1500 not reimbursed by Medicare or private health insurance to receive a tax offset of 20% (in 2006-07).

The Association is considering a new submission to the Gillard Government in the hope that we can cooperate to advance the cause of keratoconus patients.

But that could take time. So in the meantime, we suggest members put pressure on their private health funds to recognize the special nature of contact lenses for keratoconus and to provide higher rebates on claims for these specialized and indispensable lenses.

With the assistance of the US Keratoconus Foundation, we have prepared a letter which members can download and print to send along with their contact lens claims to their private health fund. Please send this letter to your health fund EVERY TIME you submit a claim for a rebate on your contact lenses.

Letter to request a higher rebate from your health fund (in pdf format)

 

Previous action on contact lenses

For some time now, Keratoconus Australia has been slowly gathering material to support our case for a fairer deal on RGPs.

In 2003, former vice president Matt Vaughan prepared an interim report on the cost of RGPs and the factors behind the high prices charged by some optometrists and the low rebates offered on these lenses by the private health funds. This report can be found here.

The Association then decided to obtain a better picture of what costs are being incurred by members and how they feel about the current setup. Surveys were sent to all members (and are included in our membership kits).

The preliminary results were compiled and used as the basis for a submission put to a meeting with the private health funds in early December 2004. The submission can be downloaded and read in pdf format. The submission also includes a summary of the key survey findings to date.

The key survey result was - surprise, surprise - that 92% of respondents are not satisfied with the current private health insurance rebates on lenses for keratoconus.

Matt and KA President Larry Kornhauser also used the survey results as the basis for an article published in the December 2004 edition of Australian Optometry, the monthly newsletter published by the Optometrists Association of Australia. The article was accompanied by another by Brisbane optometrist, John Mountford, who urged all optometrists to take action at several levels to support the Association's case for higher rebates on contact lenses for keratoconus.

Those articles can be read at

Keratoconus: Towards fairer rebates on contact lenses by Matt Vaughan and Larry Kornhauser

It’s time for all good people to come to the aid of the party by John Mountford, Brisbane optometrist

Australian Optometry published a follow-up article on the outcome of the Association's meeting with the private health funds in its March 2005 edition. This can be read at

KA puts case for higher contact lens rebates to Private Health funds by Larry Kornhauser, President of Keratoconus Australia

In April 2005, Keratoconus Australia had further exchanges with John Mountford about the issues raised by the private health funds regarding higher rebates for RGPs. Attention focused on ways of limiting the number of optometrists qualified to do contact lens fits and the problems caused by inexperienced optometrists trying to fit RGPs on keratoconus patients. These relate to possible physical damage to the cornea and the financial hardship created under the present Medicare and private health care rebate systems that often prevent patients seeking a second opinion from a more qualified practitioner.

The result was another article in Australian Optometry (May 2005 edition) which calls for better qualifications and experience for optometrists wanting to fit lenses for keratoconus. It can be read here

Dabbling in Keratoconus: fair or foul? by John Mountford, Brisbane optometrist

Keratoconus Australia would appreciate assistance in pursuing this campaign in the future. If you have knowledge about the workings of Medicare and private health funds - or just want to lend a hand, please contact us at info@keratoconus.asn.au

 

 

 

y 2007