EXCLUSIVE: Government Cuts Medicare Claims for Professional Rugby

Hugh Adams June 25, 2014 25

No GravatarAs if the Australian Rugby Union was not in enough trouble already.  Green and Gold Rugby can reveal that Jenny Benjamin, the National Manager of Medicare and Veterans Branch has informed ARU CEO Bill Pulver that Medicare expenses will no longer be covered by Medicare and will have to be paid for by the franchises and the ARU.  

In other words, Super Rugby clubs will now have to pay for their own scans and other medical treatment for players which will cause extra financial strain on their already tight budgets.  This is the case for all Australian sports but places Australian Rugby in a precarious predicament due to their existing financial situation.  This decision is ominous for the future of Australian Rugby as it has the potential to bankrupt them.

Quade Cooper AC injury Reds v Rebels_140517_060Talking to G&GR, ARU CEO Bill Pulver expressed concern over the plans.

“In essence, if the Government proceeded with this change it would add substantial cost to the Australian Rugby industry.  As a consequence we are now in a close dialogue with the Government in an effort to put a stop to these plans” he said.

Medicare have highlighted the fact that under subsection 19(3) of the Health Insurance Act 1973, Medicare benefits are not payable in respect of a professional service in circumstances where the patient’s employer is liable for, or has paid for, the service, or where the service was connected with the person’s employment.

A review by the Medicare Department of Human Services decided that it would not be beneficial to continue funding sporting medical expenses and have thus, discontinued processing claims as of May 24 2014. In other words, this change will be backdated to May 24, applied to all professional sport.

Currently, an MRI scan costs $330 and a CT scan costs $250. With no Medicare rebate, private insurance will not pay up and there is no bulk billing, which means the player will need to pay cash on the spot and then claim the money back from the franchise.

pocock-injuryThis is the same in the ER when a player gets a cut or knock. In one franchise, just last week one player had 3 stitches put in at a cost of $836.  Another player had an internal scan and check up which cost $2140. Again, without any rebate, franchises will be fully responsible for these costs.  This same franchise had 5 MRIs, just last week (total cost more than $1500).

Then there’s sports medicine – vital in the modern game.  For just one well known super player’s recent knee injury, he’s had three physio sessions on a specialist running machine where the physio cost $160 and the machine time ($200 per session). Not to mention an MRI ($330) and specialist consultation ($240). Total: $1650

Many clubs are already struggling and some rely on the Australian Rugby Union for financial aid.  This issue has the potential to be very problematic for Australian Rugby at precisely the wrong time.

Discussion

  • Beer Baron

    How is this different from every other work place (Employer being responsible). Why should medicare pay for sporting injuries. I thinks its a long bow to draw to claim that physio and scans could cause the bankrupting of Australian rugby

    • Doc

      As an employe injured at work you can claim work cover, sports people will not be able to do this
      As an employee attending ED you are treated as an Australian citizen and covered by Medicare. Sports people will not be treated this way
      As an employee with Medicare and private cover you will be entitled to a rebate in your expenses. Sports people will not

      • Sportsdoc

        Professional sports franchises can (and should) come under work cover legislation. It is their professional job ( however dangerous). There has been precedent. For some years the waratahs were covered by one of the workcover insurers ( Allianz I think) but stopped bcos the premiums were high , and hey, why not let the taxpayer foot half the bills!

    • bad ass

      Medicare covers the cost of all workplace injuries up to the Medicare rebate, as they do for all injuries for all Australians. If I read this story correctly, giving no Medicare rebate to rugby players means that Medicare saves money on professionals because of the wording on the legislation. However, some dickhead who gets drunk and brakes his hand in a fight or cuts his arm on glass breaking onto someone’s house is covered by Medicare. Private health insurance only pays for inpatient treatment. Looks like the only option is workcover if available to professional sports people.

      • http://lifeinthefastlane.com/ Mike Cadogan

        Agreed
        However, sports professionals are not covered by work cover/workers compensation…hence the issue

  • Train Without A Station

    Correct me if I’m wrong, but wouldn’t the majority of these not be covered by Medicare anyway?
    Whilst I am aware that X-Rays are covered, I was informed when I needed one that MRI’s were not. Physio is not covered by medicare either is it?
    Surely X-Rays and general emergency room visits are the only items at risk?
    But also, would private health cover not cover all these additional items (Obviously if the person had it).

    • Pedro

      All those things can be covered by Medicare. It just comes down to eligibility (MRIs are covered if referral is from a specialist) and how much of a gap payment a department thinks they can get away with charging. Sometimes private health insurance may cover the gap. Many places will also charge you and then tell you to take your account to Medicare or your private health provider for a percentage rebate.

  • Pedro

    I feel sorry for the departments that will have to repay Medicare and then chase up payments.

  • Doc

    All super XV players have Medicare and private insurance as part if eligibility to play in competition.
    Medicare used to cover cost of player attending ED for treatment, but this looks set to go.
    Without Medicare, players look likely to be unable to use private insurance.
    All sports professionals are not able to use work cover for injuries as not covered for this.
    Issues arise about when players can be treated as Medicare viable (non-work related illness or injury) and how the definition of sports professional is emoyed.
    Sports players will fall in a hole between being Australian citizens with full private insurance but being billed as foreign nationals with no reciprocal rights without insurance and therefore be billed as such.

    • Dingo

      That is incorrect. A portion of each players Super Rugby match fee goes to a RUPA insurance fund, which is not private health insurance. Bar that, there is no mandatory requirement. It is the players call if they want private health insurance.

      • http://lifeinthefastlane.com/ Mike Cadogan

        In our franchise we have 100% compliance with private health fund uptake. But I would assume that uptake rate would diminish considerably if the players are unable to utilise the insurance in the absence of Medicare coverage.
        I find the whole concept somewhat disturbing, difficult to enforce, and open to fraud.

        If my reading is correct then players injured in the line of duty are not entitled to use their private health funds, medicare or work cover to cover operative intervention, emergency department attendances or reduce the gap on appropriate radiological imaging without Medicare corroboration.
        I can only assume that we will see a lot of burly chaps attending scans on the premise that they ‘tripped over the dog whilst out walking’…in their rugby gear…and boots

  • dsb

    Sacre Bleu!

  • whassaname

    If this just for professional rugby, or all professional sports?

    • matty__k

      All professional sports

  • Basos

    The Abbot Gestapo Government will not cover you for anything and will pay you $2 per hour for your services. Enough said on the current World.

  • kebbie

    nd heres the scoop dress down change ur attire and role up to any hospital in an ambo or by car … public that is
    the bit here i think may be missing is the private hospital Tx plan
    so perhaps im wrong but all and sundry are entitled to health care-considering ur fri /sat muppet brigade then surely a clean livin jock deserves a bit more

  • Rebel Rouser

    I work in an inner city public hospital. A very common ED presentation on a Friday night is called a ‘fight bite’ – where someone punches another person in the face, but in doing so cuts their hand on the other guys teeth (can actually be quite dangerous due to the fact that generally the person’s oral hygiene is less than stellar).

    So under this proposal, if someone comes in with a fight bite and I ask them: ‘Hey lad, how’d you get this?’ then only of the following two people gets antibiotics, stitches and medical advice.
    Guy 1. ‘I was drunk as a skunk and thought my best mate was trying to steal my gf, so I punched him one’
    Guy 2. ‘I was representing my country against the All Blacks and that mouthy little Jimmy Cowan wouldn’t stop running his mouth off…’

    Which one would you rather? :P

    • Colonel Klinc

      Well put, but the Wallaby is technically at work, and should be covered by some kind of workers comp. I am surprised this has been allowed for as long as it has. Looks like it has been a rort since the pro era commenced. A shame though…

  • SuckerForRed

    I was talking to a player a year or so ago and the subject of player welfare, medical treatment, and what might happen if they had to give up due to injury came around. Conversation went something like this:
    Me: So what is your opinion of how player welfare is managed?
    Him: It sucks.
    Me: So what would happen if you were severle injured and could not work at all?
    Him: I would be in serious sh*t. We are not covered by workers comp or private health insurance. Insurance cover that is there is quite low and wouldn’t be surficient to treat, say, a spinal injury.
    Me: So what the hell can you do to protect yourself?
    Him: I have taken out additional insruance. But it costs a fortune and most people wouldn’t be able to afford it and I don’t know how long I will be able to afford it.
    Let’s make this clear – Sporting bodies can not take out a Work Cover/Compensation policy that the average employer has to take out because sports are specifically excluded in most legislation. Private health insurance policies do not cover treatment for injuries occuring during your ‘normal’ employment – e.g. being paid to play rugby. Now with medicare removed the whole cost is going to have to be born by the club or the player.
    Now, if you think that this is just going to effect the professional players amoungst us, think again. You know those forms that you sign at the start of every season when you sign up to play with you local club? They are so that you are covered by the insurance that the club has to take out to operate. And even though you do not recieve money for playing, or for the work that you might do around the club as a volunteer, in the eyes of the law you are still regarded as being ‘employed’.
    So where does that leave you, me & the C grade prop? Who knows.

  • GD

    Slightly off topic but can someone do an article explaining why the ARU has no money? From a punters perspective I think most people think there must be a lot of cash – we see high ticket prices, high merchandise prices and highly paid players, it’s like rugby self-selects it followers making it an exclusive sport. An article outlining the issues causing the financial crisis would be great. Cheers

  • Sdre

    I think there needs to be more transparency in the numbers. Telling it as it is is not good enough.

    Employer : “We are cutting your basic benefits. deal with it”

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