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PHI but we've waived obstetrics


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#1 mummame

Posted 04 December 2012 - 05:47 PM

Okay,

I may have found myself in the situation of a surprise pregnancy and we waived obstetrics, believing we would not be adding to our family any time soon. I had DD in June 2011 and I think I called off the obstetrics soon after that.

So if we wanted to go back to the private hospital where all 3 of my children have been born am I right in assuming we would pay for everything? The $5000 delivery fee. Has anyone been in this situation? Is there any sort of loopholes I can get through? This is all a big surprise and I was not planning for a few years so therefore had not increased our cover. I may have to go public, was trying to avoid this, not really liking the public hospital here.

TIA

#2 lamarque

Posted 04 December 2012 - 05:52 PM

Yes, if you're not covered by PHI and you choose to go to a private hospital, the expenses are all yours.

I'd also imagine the 5K delivery fee doesn't include the OB's fees etc.


#3 EsmeLennox

Posted 04 December 2012 - 05:54 PM

You could perhaps negotiate with your health insurer to pay the equivalent of the premium you would have paid had you not waived the obstetric cover? Not sure you'll get anywhere, but I'd give it a shot, especially if you have been with the same insurer for a reasonable period of time.

#4 lep_78

Posted 04 December 2012 - 05:56 PM

unless you have a spare $20000  or more sitting around i would go public. For the private hospital you could ring them and they should be able to give you an idea of cost. you will have delivery room cost, room cost, OB cost, Pead cost, if you have an epidural or C=Section the cost of the anaethetist, operating room cost, assistant cost. then if your child needs special care nursery there will be a cost. then the cost for blood tests, scans and heaven forbid any intensive care costs. having a baby can have many complications that you might not factor in that will cost you if you need to be admitted. Personally i wouldn't risk it.
congratulations on the pregnancy.

#5 SeaPrincess

Posted 04 December 2012 - 06:00 PM

QUOTE (Jemstar @ 04/12/2012, 03:54 PM) <{POST_SNAPBACK}>
You could perhaps negotiate with your health insurer to pay the equivalent of the premium you would have paid had you not waived the obstetric cover? Not sure you'll get anywhere, but I'd give it a shot, especially if you have been with the same insurer for a reasonable period of time.

I think this would be your only chance, and definitely worth a shot!

I think $5000 is nowhere near enough.  Accommodation alone at one of the hospitals where I had a baby was $500/night, 5 years ago, so even a minimum stay of 3 nights would be $1500.  During that pregnancy I spent a total of a month in hospital, so you wouldn't want to have anything go wrong.

#6 Mousky

Posted 04 December 2012 - 06:02 PM

My guess is wwwaaayyyy more than $20000. If you have baby at 34 weeks (minimum baking for lots of private hospitals) and you have any complications, you might need to sell the house.

#7 Melissam12

Posted 04 December 2012 - 06:05 PM

What is your local hospital?
Private midwifery care might be cheaper than private obstetrics if you have a private midwife in a public hospital.

#8 Jax12

Posted 04 December 2012 - 06:09 PM

QUOTE (Jemstar @ 04/12/2012, 03:54 PM) <{POST_SNAPBACK}>
You could perhaps negotiate with your health insurer to pay the equivalent of the premium you would have paid had you not waived the obstetric cover? Not sure you'll get anywhere, but I'd give it a shot, especially if you have been with the same insurer for a reasonable period of time.

Give it a shot but don't hold your breath.  DS's due date was only a week or two out of the waiting period from when I added maternity cover and they wouldn't budge.  Not even after having been covered by them for nearly 30 years.  I threatened to change providers, called around to see what others would offer...no luck.

But that is a different scenario to yours OP so you never know.  If you can't get private cover I would go public if I were you.

Good luck

#9 MrsShine

Posted 04 December 2012 - 06:11 PM

You could possibly see if any Ob's in your area deliver in the public hospital, then you'd only be out of pocket their pregnancy management fee but have the baby as a public patient? You still get all the benefits of OB care but just not pay for the private hospital admission, epidural separately and all of that.

Otherwise yes, if there is group midwifery offer you could try that which is 100% free.



#10 mummame

Posted 04 December 2012 - 06:16 PM

The reason I said $5000 was that has been the cost of the bill I have always been sent at the end of my pregnancy, meaning thats why the PHI has paid. I know all the other costs as I have gone private for the other 3 babies and the OB cost is about $2000 as well as all the scans etc. I am assuming I would be up for the bill cost AS well as everything else, so it really wouldn't be worth it. I may be able to get in with a penalty fee as PP have suggested, that was my first thought too, just giving them a call to see what they can do, not sure if it will work but worth a go!

#11 Hooray Henry

Posted 04 December 2012 - 06:30 PM

I have the Statement from my Health Insurance Provider here, they paid $9203 (of a bill of $9703) for the hospital stay following the birth of my son in August.

On top of this I paid my OB $200 for the initial visit, $100 for subsequent visits, and $5000 pregnancy management fee.  I also paid for scans.

This was for an uncomplicated repeat c section.  

Hope this gives you some idea of the cost.

#12 IsolaBella

Posted 04 December 2012 - 06:34 PM

Like PP my hospital bill alone was close to $10 k. OB was around $3k.

My sister ended up having a 35 wk bubs and she had complications herself and ended up in ICU..... Their bills were around the $40k mark.

#13 Soontobegran

Posted 04 December 2012 - 06:38 PM

I wouldn't be too hopeful about the PHI being kind to you unfortunately.
My DD 2 had been in top PHI since biirth but hadn't added obstetrics to hers as she was not planning a baby.
She got pregnant and as soon as she found out she went to them and asked if she could back pay the 2 months at the higher rate and then pay the full year in advance would they let her take Obstetrics and they said NO. She even went to 2 other insurers asking the same thing and they all had the same answer.
Good luck OP but to go private in private without PHI will potentially cost you many thousands of dollars.

#14 elmo_mum

Posted 04 December 2012 - 06:48 PM

i was booked at a private hospital in melb

at pre pregnancy info night, the admin man went through the costss if paying yourself
$10000 for a vag delivery, no complications, 4 night stay
$15000+ for c sect - no complications 5 nights
+pead + aneathetist  + obs



bear in mind, poss complications - i ended up having surgery at 16w and hospi stay from 17w-24w (transferred to public)
my phi "bill" was $17000 + i still had pathology and u/s

if i were you i would either:
go public all the way
fin a private ob in a public hospital - then you would pay their fee - poss $5k

good luck

#15 Fright bat

Posted 04 December 2012 - 06:58 PM

QUOTE (soontobegran @ 04/12/2012, 07:38 PM) <{POST_SNAPBACK}>
I wouldn't be too hopeful about the PHI being kind to you unfortunately.
My DD 2 had been in top PHI since biirth but hadn't added obstetrics to hers as she was not planning a baby.
She got pregnant and as soon as she found out she went to them and asked if she could back pay the 2 months at the higher rate and then pay the full year in advance would they let her take Obstetrics and they said NO. She even went to 2 other insurers asking the same thing and they all had the same answer.
Good luck OP but to go private in private without PHI will potentially cost you many thousands of dollars.


There are exceptions to this. I called my insurer before we started TTC and 'confirmed' that we were covered for obstetrics with our plan (because it had several levels of cover all called the same thing, some which incuded obs and some which didn’t' and it was all pretty confusing). And then found out at 20 weeks that that plan didn't include obstetrics.

They had a computer log of a call being made to them around the time I thought I had checked, but they had not recorded the content of that call. I ultimately got put through to a lovely manager who agreed to escalate it on the basis that there was a call logged, and that I had in fact booked my Ob and private hospital on the basis that I believed I was adequately covered.

It took two weeks, but they agreed to upgrade my cover from the time of the logged mystery phone call (in which I would have upgraded anyway) and I paid the $150 difference between the premiums. We'd also been with them for a decade at that stage.

In your case, though, OP, I suspect that given you voluntarily gave up your cover, you have no choice.

And no, I would not risk paying for private.

#16 Soontobegran

Posted 04 December 2012 - 07:05 PM

QUOTE (MsN @ 04/12/2012, 07:58 PM) <{POST_SNAPBACK}>
There are exceptions to this. I called my insurer before we started TTC and 'confirmed' that we were covered for obstetrics with our plan (because it had several levels of cover all called the same thing, some which incuded obs and some which didn’t' and it was all pretty confusing). And then found out at 20 weeks that that plan didn't include obstetrics.

They had a computer log of a call being made to them around the time I thought I had checked, but they had not recorded the content of that call. I ultimately got put through to a lovely manager who agreed to escalate it on the basis that there was a call logged, and that I had in fact booked my Ob and private hospital on the basis that I believed I was adequately covered.



I'd hope they'd make exceptions when you've proven you made a call to check your status but DD2 dropped it just like the OP and they wouldn't entertain the thought even with lengthy enquiries to head office etc sad.gif
She eventually went to the MWC and was happy with the care anyway.

#17 premmie_29weeks

Posted 05 December 2012 - 12:18 PM

If you don't have phi covering obstetrics I wouldn't deliver at a private hospital. The accommodation costs alone would be $500 a night, not to mention the costs of a csotentially or god forbid a child needing special care.

My ob delivered at either e private or public hospital in randwick (I'm in Sydney) the costs were about the same and we had phi so chose to go private for the private room. Maybe check if your ob will deliver in a public hospital. That way the scans, and accommodation plus any special care is covered.

#18 Gembac8019

Posted 05 December 2012 - 03:41 PM

Same happened to me. Thought we were done having kids and dropped obstetrics out of our PHI. The minute I found out I had fallen pregnant (and yes, we have been with them for a long time too) I asked if we can backpay like the op wants to. Not a chance. Nowhere else will either. You must have obstetrics for 12 months before I was told.




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