a fairer deal on RGP contact lenses
by the cost of rigid gas permeable (hard) contact lenses? We are
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
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.
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.
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
We have summarized Ms Davidson’s response
• 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
• 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).
Association is considering a new submission to the
Gillard Government in the hope that we can cooperate to advance
the cause of keratoconus patients.
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.
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.
request a higher rebate from your health fund (in pdf format)
Previous action on contact lenses
some time now, Keratoconus Australia has been slowly gathering
material to support our case for a fairer deal on RGPs.
former vice president Matt Vaughan prepared an interim report on
the cost of RGPs and the factors behind the high prices charged
optometrists and the low rebates offered on these lenses by the
private health funds. This report can be found here.
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).
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
key survey result was - surprise, surprise - that 92% of respondents
are not satisfied with the current private health insurance rebates
lenses for keratoconus.
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.
articles can be read at
Towards fairer rebates on contact lenses by
Matt Vaughan and Larry Kornhauser
time for all good people to come to the aid of the party by John Mountford, Brisbane optometrist
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
puts case for higher contact lens rebates to Private Health
Larry Kornhauser, President of Keratoconus Australia
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
systems that often prevent patients seeking a second opinion from
a more qualified practitioner.
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
in Keratoconus: fair or foul? by John Mountford, Brisbane optometrist
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 email@example.com