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Private Health - Q&A


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#1 mini-us

Posted 08 February 2013 - 11:01 PM

Hi

I got a question re private health cover and what to ask for. I know that I have private health cover. I tried to find out today what I'm actually covered for with them, now that I'm pregnant, but I got a guy and he was not very helpful. All he could tell me was that I don't have any waiting times, whatever that means.

Could you guys give me some points I need to check with them and questions to ask and make sure what I'm covered for?

Also, there was a flyer in the letterbox yesterday abut a community midwife program. Any ideas what they are for?

I'm really sorry, but a) I'm new to being pregnant, and b) I'm not an Australian, so I have no idea how it all works here (I have no clue how it works back home either, but there I have family, whereas here I have no one to ask except you...)

Cheers and thanks

#2 bluedragon

Posted 08 February 2013 - 11:40 PM

I'm in the oct group but saw this come up in recent topics.

You need to ask your private health insurance company if your policy covers maternity. If it does and you have no waiting periods then you would be covered for the hospital fees at a private hospital. You will still have out of pocket for the OB, will be a few thousand but depends on the specific OB.

The midwife programme is probably run through your local public hospital, it may be for a birth centre but couldn't be 100% about that without seeing the flyer.

HTH

#3 Wildence

Posted 09 February 2013 - 12:11 AM

Unfortunately they don't cover you for much, only benefit is may be getting a private room (is covered by the health fund), but you will need to pay for  pretty much everything else.

I don't know whether community program is the same program as Midwifery group practice, and if it is, i would highly recommend going for midwifery program (if run by the hospital near you)

Good luck!




#4 EsmeLennox

Posted 09 February 2013 - 12:40 AM

It really depends on your insurer OP.

If you go private and see a private obstetrician:

Outpatient services (eg visiting your dr in his consulting rooms) are not coved by PHI but you get a Medicare rebate (if you are eligible for Medicare - do you know if you are OP) which covers some of the cost. You will pay a fee for blood tests, ultrasounds etc, but again some of this will be covered by Medicare if you are eligible.

Inpatient services (eg when you are in hospital to have your baby) are usually substantially covered, but how much depends on your policy. Best case scenario you could pay nothing out of your pocket, worst case it could be a few thousand. You need to contact your insurer again and ask them to tell you exactly what is coved, hospital accommodation, obstetrician fees, aneasthetists (if necessary) etc.

It is inaccurate to say you will pay for pretty much everything except your accommodation.

The community midwifery program is a home birth service. You can also have your baby in a public hospital and pay nothing (again, depending on your status for Medicare).

#5 mini-us

Posted 09 February 2013 - 12:19 PM

Hi

and thanks very much for the answers. I'm fully Medicare covered too, the Community Midwife Program is this one: http://cmwa.oolybooly.biz/
I had a look at my PHI with Bupa policy online, it says following:
-  covered for anesthetist 25% of the MBS Medicare Benefit Scheme fee, but no GAP
- commendation
- you are not covered for when you have not been admitted into a hospital and are treated as an outpatient (e.g. outpatient ante-natal consultations with an obstetrician)
It does not mention anywhere anything else about maternity. Is it worth changing the provider?

Up to now I've been twice to the GP, and one blood test, and both times I paid nothing, they were just interested if I had Medicare.

So basically, if I go private, I pay, if I go public, I pay nothing?

An OB is the one who pulls the baby out, right? Do public hospitals don't have one that you have to go to a private OB? So just any doctor available would attend the birth?

I'm so sorry. I'm really confused, back home all would be done by Gynecologist from start to end.

Thanks

#6 tibs

Posted 09 February 2013 - 12:24 PM

Here an OBGYN is an obstetrician gynacologist i.e. they mostly do both.  If you are going private you will have an OBGYN who you see start to finish.  If you go public you do not have an OBGYN you just see midwives from start to finish unless you need a doctor at the pointy end and whichever is on duty in the hospital will be called in.

#7 Guest_katem666_*

Posted 09 February 2013 - 12:46 PM

Phi is hospital cover only, never covers outpatient medical (gp,obgyn appointments, ultrasounds, etc) that's what medicare is for.
Your phi will cover your private hospital stay minus any excess or copayment your policy hasYour phi will cover a portion of the dr bills for you for when you're in the hospital. For everything a dr does, there's a corresponding amount the government/medicare have decided that service should be charged at. Medicare will cover 75% of that amount, and your phi will cover the remaining 25%. If your dr decides to charge over the determined amount, you will have to pay the difference.Example: say attendance at the birth is deemed to be "worth" $500. Medicare will cover $375, phi will cover $125, but your dr charges $600,  so you pay the extra $100You will be told by your obgyn if they charge extra out of pocket.
Apologies for any lack of clarity, typing on iphone with sleeping baby on my chest...

#8 bluedragon

Posted 09 February 2013 - 12:49 PM

Yes if you go private you will be out of pocket, if you go public you shouldn't have to pay anything.

You need to look at your local hospitals and see what sort of services they offer. If you go private you will be under the care of an OB. You will see them for your regular appointments during your pregnancy and they will deliver the baby (assisted my midwives).

If you go public there are a number of ways they structure things. The most popular is to go through a midwife lead birth centre. You will have all your appointments with a midwife and midwives will deliver your baby. There are OBs at the hospital if you need to see one. Some birth centres had programmes where you see the same midwife or one of a small group (2-3) at each appointment and one of these will be there to deliver. Otherwise you are likely to see a different midwife each appointment and may or may not have met the midwife on duty when you're in labour. Birth centres usually only take low risk pregnancies. If you need a higher level of care the midwives will send you to the public OB.

Going private you will get a private room, public possibly not (my local public hospital has 3 to a room but each one is different). Private you ensure continuity of care but you will get this in some birth centres.

It sounds like you are probably covered for the private hospital fees but I would ring them to double check this or read your specific policy documents. You will be out of pocket for some of the OB and if you need an epidural or have a Ceasar you may have to pay for the anaesthetist.

I would be carefully about changing insurers as you may have to serve a waiting period again, usually 12 months.

#9 Wildence

Posted 09 February 2013 - 01:21 PM

QUOTE (mini-us @ 09/02/2013, 01:19 PM) <{POST_SNAPBACK}>
So basically, if I go private, I pay, if I go public, I pay nothing?


That's correct.

Not sure of your location OP, but if you decide to have an OB to deliver your baby, you will be out of pocket for at least 2-3k (depending where you live). So you know OB wont be there during your labor, he will only come once you start pushing pretty much.

I am on a group practice midwifery program, and i cant recommend it highly enough. You have to be low risk though (so no carrying twins, no high blood pressure etc), you will have ONE midwife assigned to you through your pregnancy, and she will also be there with you for the birth of your baby. Not many hospitals run this program and also sometimes its hard to get in. But i personally think its lovely to have the midwife you know during your labor!

Normally though, if you are a public patient, you get to see a different midwife every time you have your appointment, depending who will be on duty.





#10 Feralmummacat

Posted 09 February 2013 - 02:00 PM

QUOTE (Wildence @ 09/02/2013, 01:51 PM) <{POST_SNAPBACK}>
So you know OB wont be there during your labor, he will only come once you start pushing pretty much.


Well for me this statement is totally incorrect. My OB was there pretty much on and off the whole night and day I was in labour with DS2 (private hospital).

I was induced at 2:30am and she came into the hospital for about 1 and half hours. I had been in hospital for 2 days before hand so I was not a new admission. She was back in at 6am in morning until her first appointment at 8:30am in the morning. She checked in on me just about every hour for 10 minutes or so until 5:00pm when it was her last appointment she then stayed in the room until 7:30pm when DS2 was born. See stayed with me while the pead took DS2 to the SCN and even got me a cup of tea and sat with me until DS2 was stable.

I saw more of my OB when I was in labour with DS2 than I did of the midwife when I was in labour DS1 in a public hospital. They were both induced labours due to PROM.

OP some people will tell you public is good and other people will tell you private is good. I recommend that you make some phone calls and talk to the service providers in your area to see what services they provide.

#11 Wildence

Posted 09 February 2013 - 03:30 PM

QUOTE (mummacat @ 09/02/2013, 03:00 PM) <{POST_SNAPBACK}>
Well for me this statement is totally incorrect. My OB was there pretty much on and off the whole night and day I was in labour with DS2 (private hospital).


It is correct for most of the people unfortunately. don't get me wrong, they occasionally pop in to see how the progress is going, but normally midwife spends more time with you than an OB. They might be checking on you even more if there were complications during pregnancy, and i can also see from your signature that you had one preterm baby.

But agree OP, you should do your own research. If you are considering going private, i would suggest to call a couple of OBs to find out their fee schedule (to see how much you will be out of pocket) and you could also post here:
http://www.essentialbaby.com.au/forums/ind...hp?showforum=44
and ask if anyone else used that particular OB and how was their experience.

If i wasn't on a midwifery group practice program, I would have chosen to have an OB instead. I personally think its important to have only one person looking after you and not to see a different midwife every 2 weeks.

#12 Luci

Posted 09 February 2013 - 04:30 PM

Hi OP

Having a baby in Australian can be a bit confusing as there are a few care options available.

If you go private, you need to choose an Obstetrician, and book in with him / her. The Ob will usually have one or two private hospitals that he / she delivers babies at and you will need to book in there as well. A lot of people just go to the private hospital that is closest to where they live.  Not all private hospitals deliver babies though - you need to check this. The hospital can give you details of all the Obstetricians who deliver babies there - this would usually be on the hospital website.

If you post again with where you live, there might be EB members who could suggest a hospital / Ob in your area. Your GP will also be able to advise you as to hospitals and recommend an Obstetrician in your area.

Once you have booked in with an Obstetrician, you go to all your appointments with that Dr at their consulting rooms. You need to pay for these appointments, plus blood tests and ultrasounds. You will get some back from Medicare. The Ob will also charge a pregnancy management fee. This varies from Ob to Ob, it can be several thousand dollars. You only get a little bit back from Medicare.  You can phone an Ob's office and their receptionist will be able to tell you how much they charge.

Once it is time for the baby to be born - your private health insurance might cover the whole cost of your hospital accommodation, or, depending on your insurance policy, you might have to pay some money towards the cost yourself.  If you have an anethetist (for an epidural or caesarean), you will have to pay some of the cost of this yourself as well.

If you go public, you won't pay anything.  You would go to a public hospital, and see a midwife at most appointments. A midwife would also deliver your baby - but they do have Obstetrician's there as well, who would see you if there were any complications. If you do go public, you still need to book in with the hospital. Your GP will be able to give you details of the public hospitals in your area.

If you choose a private hospital, your private health insurer should be able to tell you if they pay all the costs of accommodation at that hospital, or if there would extra for you to pay.

Good luck, post again if you have more questions!

Luci

#13 mini-us

Posted 09 February 2013 - 06:49 PM

Hi and thanks again,

was surfing and I think the nearest public hospital for me would be Swan Hospital in Midland, Perth, WA. They seem to do offer places on this community midwife program.

I wouldn't have no clue about private hospitals unfortunately.

So an OB is actually only needed of there is something wrong, and if there is something wrong the public hospital has one anyway, correct?

I think then I would rather go with a (team of) midwife(s), have one there I know by then and trust - I'm completely weirded out by the idea of someone other than DH looking at my private parts!

#14 somila

Posted 09 February 2013 - 06:59 PM

Over 13 years ago I did shared care with my GP and the local public hospital.  I had complication-free pregnancies and births and found my care excellent.  I saw a number of midwives at the hospital and saw that as an advantage. (I always appreciate a second opinion.)
  
I fluked a private room first time around, which was great, but with DS#2 I shared with 3 other women and their babies.  I did not enjoy this at all and did not sleep at all during my 3 day stay as I was constantly disturbed and anxious that my baby was disturbing others.

If I had gone for #3 I would have considered coming home after 24 hrs and paying a nurse to visit me at home each day (don't know if that is possible LOL).

P.S.  The OB popped in during my labour to check me once, that was it.  Midwives all the way!

Edited by somila, 09 February 2013 - 07:00 PM.


#15 Wildence

Posted 09 February 2013 - 10:06 PM

QUOTE (mini-us @ 09/02/2013, 07:49 PM) <{POST_SNAPBACK}>
So an OB is actually only needed of there is something wrong, and if there is something wrong the public hospital has one anyway, correct?

That is correct. If you will need a c section, OB normally does that.

#16 againagain

Posted 10 February 2013 - 11:07 AM

Check what models of care your nearest public hospital has, if you choose that path.

Often there are a couple o different things you can choose.

I have had shared care with a GP/OB, the care being shared between him and 3 midwives, one of which you get when you go into labour. I did pay GP rates to see the Dr each time though, but I enjoyed the continuity of care.

There are also solely GP/OB care, where you just see the Dr at his clinic and then go to the hospital when in labour and have midwives until the Dr is called in. Again you pay the dr fee for seeing him.

And then of course there are different models of midwife led care - group midwife care, care where you are assigned your own personal midwife, Family Birth Centre, etc.

Really depends on the hospital and what they have available.

#17 jayskette

Posted 10 February 2013 - 11:14 AM

You need to know your membership number then you can quote that on the phone. If someone else purchased that on your behalf  or part of a joint account you will need to know whether you have the authority to enquire about things or whether they need the main account holder to ask. Most of them now have a website with a members area that you can directly download your policy from.

#18 Choufleur

Posted 10 February 2013 - 06:58 PM

mini-us in theory you should pay nothing going public - or so I hear.

In terms of private health insurance, Bupa (or whoever really they're all the same) pays almost nothing. They pay for the nice room in the hospital. The federal government changed the rules a few years ago which meant that obstetrics are now not allowed to be covered by PHI, it's a total joke. Anyway...

I went private with DD, for me it's about continuity of care, seeing the same OB at every appointment etc, and as a back-up in case something goes wrong, it's someone I know and trust. I paid an awful lot of money, my OB fees, every appointment I saw her, plus all the scans etc. My OB - or OBGYN as a lot of people call them, they do both - was really lovely, I'm going back to her for the 2nd baby even though it's a bit further to travel now we've moved house.

At the end of the day, do what you feel is right for you, both personally and financially. If you choose to go private and you haven't booked in yet, you may be too late. I booked in this time with my OB the day I got my BFP. Last time I booked in by 6 weeks.

Good luck original.gif

#19 Mozzie1

Posted 10 February 2013 - 07:15 PM

QUOTE (tibs @ 09/02/2013, 01:24 PM) <{POST_SNAPBACK}>
Here an OBGYN is an obstetrician gynacologist i.e. they mostly do both.  If you are going private you will have an OBGYN who you see start to finish.  If you go public you do not have an OBGYN you just see midwives from start to finish unless you need a doctor at the pointy end and whichever is on duty in the hospital will be called in.


I just want to add that you will see an Ob throughout your pregnancy if you need to. I was classified as high risk due to pre existing high BP at 14 weeks, and saw obstetricians for the rest of my pregnancy. that was at a public hospital in Sydney.

#20 Cranky Kitten

Posted 10 February 2013 - 11:02 PM

Essentially what the PP have described is correct with regards to private/public hospitals.

The flyer you got about the Community Midwifery Program is a publicly funded midwifery program in Perth. They have two main options, either homebirthing (the majority that they do) or what is known as a "domino birth" where you see your midwife for all your antenatal care etc, then the same midwife will attend you in labour at a public hospital of your choice. Places for the CMP are quite popular as I understand it and you'd need to contact them pretty quickly if that's the route you want to take, same as if you're wanting to book in with a private obstetrician, as their books also fill up very quickly.




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