New Arrangements for surgically implanted prosthetic devices

30th August 2005

Effective 31st October 2005, members with hospital cover will potentially have new arrangements for surgically implanted prosthetic devices payable by Navy Health during a hospital admission. Should you or others on your membership ever require a surgically implanted prosthetic device, this information will be of importance. A few common examples of prosthetic devices include hip and knee joint replacements, heart valves, pacemakers and intra-ocular lenses used for cataract surgery. 

New legislation has been passed that provides a co-payment for certain devices on the Commonwealth Prostheses Schedule List. The new arrangements will establish a more competitive framework for the pricing of devices than that which currently exists. Please be assured that this does not mean patients may be forced to pay a co-payment for an essential device, nor does it mean that your Doctor’s decisions will be compromised or limited. It does mean, however, that for the first time devices will be subject to clinical review of their effectiveness and, suppliers of approved devices will be encouraged to compete on the basis of price. The direct beneficiary of this arrangement will be you, the member. 

At the same time the legislation contains significant safeguards for members ensuring that they will, at all times, be guaranteed 100 percent coverage of the cost of devices determined as being clinically appropriate by qualified medical practitioners. Although the legislation makes provision for a co-payment in some circumstances, it should be remembered that this will only occur if the supplier of a device insists on a price which is higher than that accepted by the Clinical Assessment Committee. 

Navy Health accepts its responsibility to provide coverage for appropriate and safe health treatments, especially those made possible by technological innovation. The new legislation will enhance this objective while maintaining affordability. 

Once the initial recommended Prostheses Schedule List has been finalised by the Commonwealth working parties (clinical and commercial), Navy Health will publish details of the Prostheses Schedule list on the Navy Health website (www.navyhealth.com.au). We have been advised that this initial list should be available to us by late August-early September.  

The new prostheses changes make it imperative to check with your Doctor to determine whether a surgically implanted prosthetic device will be used and if it is included on the approved Prostheses Schedule.  

Navy Health is here to assist with any enquiries you may have in regards to the new prostheses reform. Where possible, we also advise that members should contact the Navy Health Claims Department on 1300 30 6289 (NAVY) to obtain benefit information prior to any hospital admission.