Many of my clients come to see me who have seen their Dr time and time again as they are suffering from the symptoms of having low thyroid hormone.  It is partially frustrating for them, that after pathology is completed with me, they find out they have Thyroid Antibodies pointing to the auto-immune disease, Hashimotos.

So why don’t the Dr’s test more than the TSH?

Medicare is your answer.  The Dr’s are bound by specifics and it not their fault.

For the costs of a test to be covered on Medicare they have certain rulings around what test will be covered.

For Thyroid there are a few different rulings:

 

Item 66716

For Thyroid, this ruling states 66719: TSH quantitation

Thyroid function tests (comprising the service described in item 66716 [above] and 1 or more of the following tests – free thyroxine, free T3, for a patient, if at least 1 of the following conditions is satisfied:

(a) the patient has an abnormal level of TSH; [See Rule 9 below – it says “outside the normal reference range”]

(b) the tests are performed:

(i) for the purpose of monitoring thyroid disease [it has been previously diagnosed] in the patient; or
(ii) to investigate the sick euthyroid [a normal thyroid that is affected by an illness or accident] syndrome if the patient is an admitted patient; or

(iii) to investigate dementia or psychiatric illness of the patient; or

(iv) to investigate amenorrhoea [when you don’t get a period] or infertility of the patient;

(c) the medical practitioner who requested the tests suspects the patient has a pituitary dysfunction;

(d) the patient is on drugs that interfere with thyroid hormone metabolism or function (Item is subject to rule 9)

 

Rule 9:

Thyroid function testing
9. (1) For item 66719: abnormal level of TSH means a level of TSH that is outside the normal reference range in respect of the particular method of assay used to determine the level.

9. (2) Except where paragraph (a) of item 66719 is satisfied, the amount specified in the item is not payable in respect of a pathology service described in the item unless the pathologist who renders the service has a written statement from the medical practitioner who requested the service that satisfies subrule (3).

9. (3) The written statement from the medical practitioner must indicate:
(a) that the tests are required for a particular purpose, being a purpose specified in paragraph (b) of item 66719; or

(b) that the medical practitioner who requested the tests suspects the patient has pituitary dysfunction; or

(c) that the patient is on drugs that interfere with thyroid hormone metabolism or function.

So, that is why you won’t get more out of your Dr because he is scripting for you for tests that will be paid under Medicare. So they are doing as much as they can within Medicare boundaries.

It may be more convenient (cost and time effective) to get a full thyroid profile done through a functional practitioner.  This saves your Dr having to justify and conform to Medicare’s ruling and saves you time of two Dr’s visits plus your time off work to do so – one for the initial appointment and the second to go back for the results before you are able to take action on them with your functional practitioner. 

Reference:

Medicare Benefits Schedule Book
Category 6
Operating from 1 January 2019

http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/1E8EDDDB20264E41CA2583610081D914/$File/201901-Cat6.pdf

 

 

Pin It on Pinterest

Share This