Jump to content

Complex Medibank/Medicare qn
Unexpected $2500 OOP!!


  • Please log in to reply
17 replies to this topic

#1 Lokum

Posted 15 February 2013 - 12:19 PM

So I was in labour for 9 hours and stupidly called for an epidural in my private hospital.

Anaesthetic  came and administered it, advising that there would be an OOP because it was out of hours call (around 9pm.) I think she said around $750 OOP, or maybe I thought that because that's how much it was for my midnight spinal last time.

Epi didn't work.  I could still feel every contraction and could feel when a midwife accidentally scratched my belly while adjusting the CTG monitoring belts.

10 mins later, OB said we'd have to have a c/s. Obviously, this epi hadn't worked sufficient to get me through surgery, so I had to have a spinal as well. (If I'd only waited 10 more minutes  cry1.gif )

Anaesthetist said sorry, but because we're now doing a diff kind of anasethetic, there'll be another OOP for this.

I thought, great, now the OOP will be up around the $1500 mark.

Bill came (2 invoices, one for epi & one for spinal), with total 8 items, and bill of $3490. Sent it off to Medicare who passed it on to Medibank. Medicare have provided cheque for around $890 - 75% all the scheduled fees for those services.  Medibank have provided cheque for $272 (25% of the scheduled fees.)

This leaves me with a bill for approx $2500 just for anaesthetic services. I'm flabbergasted. We have mid level hospital cover with no excess. I didn't get a bill from my OB for the c/s - Medibank and Medicare covered the lot.

How come Medibank isn't covering more of the actual cost of these services? Is it too bad so sad, or is there any chance they've stuffed up?

#2 bark

Posted 15 February 2013 - 12:24 PM

Sounds right to me unfortunately. Yr private health only covers the gap not paid by Medicare according to their schedule. Private health is basically to cover your hospital stay - yr accommodation.

#3 Bluenomi

Posted 15 February 2013 - 12:30 PM

You've got a gap because you were charge above scheduled fees. PHI is only legally allowed to pay upto the schduled fee, the rest is up to you to pay. It sucks which is why people try and get no gap doctors but that doesn't work in emergency situations.

Anaesthetists are some the most expensive doctors so their out of pocket is usually huge.

#4 MrsLexiK

Posted 15 February 2013 - 12:33 PM

QUOTE (Lokum @ 15/02/2013, 01:19 PM) <{POST_SNAPBACK}>
How come Medibank isn't covering more of the actual cost of these services? Is it too bad so sad, or is there any chance they've stuffed up?


I don't think they have stuffed up, your OB should have made you aware of the costs.  We were given a sheet with the max OOP expenses we would face for epi's or c-sections and it had different amounts for different days.  If I was booking in for an induction with an epi or a scheduled c-section I would be able to call up and find out the costs and see if I could work around one that works with my health fund for gap, however if it is going into labour normally you get what they charge you.

I am very thankful that my OB is a gap provider with medibank and my mangement fee is costing around $600 - $800 (depending on which hospital we have to go to now) and that is before the medicare rebate.  I have budgeted for the epi or c-section costs

#5 Rach_V

Posted 15 February 2013 - 12:34 PM

It does sound right unfortunately. Your out of pocket costs depend on how much each individual doctor charges as well as whether or not they participate in your health fund's "gapcover" schemes, where the health fund will pay higher rebates than the usual 25% (there are limits, rules, etc for participation in such schemes).

If you didn't get a bill from your ob, it sounds like your ob participates in Medibank's gapcover scheme and accepts their gapcover schedule as full payment.

You could call the anesthetist and ask them if they do use Medibank's gapcover, you may still have to pay out of pocket costs but these can be reduced if they do use it. However, I believe that Medibank cap the total amount payable by the patient to $500, which means the dr has to reduce their fee significantly in many cases, hence a lot of them won't participate.

The world of private health insurance is complex. Even if you had the highest possible level of private health insurance, you would often still have out of pocket costs associated with your surgery.

Edited by Rach_V, 15 February 2013 - 12:35 PM.


#6 IsolaBella

Posted 15 February 2013 - 12:38 PM

QUOTE (bark @ 15/02/2013, 01:24 PM) <{POST_SNAPBACK}>
Sounds right to me unfortunately. Yr private health only covers the gap not paid by Medicare according to their schedule. Private health is basically to cover your hospital stay - yr accommodation.



QUOTE (Bluenomi @ 15/02/2013, 01:30 PM) <{POST_SNAPBACK}>
You've got a gap because you were charge above scheduled fees. PHI is only legally allowed to pay upto the schduled fee, the rest is up to you to pay. It sucks which is why people try and get no gap doctors but that doesn't work in emergency situations.

Anaesthetists are some the most expensive doctors so their out of pocket is usually huge.



Yep this is the case.  DS2 is about to have Grommets put in again. $1,050 for  ENT and we get back $360 and $700 for anaesthist which we get back $350. As PP said PHI only covers the gap between the Medicare rebate and the scheduled fee.

For my cs the OB was no gap, but Anaessthest OPE were from a small $250 for out if hours emerg one to $850 for the one which was day scheduled. They just billed at different rates.



#7 Soontobegran

Posted 15 February 2013 - 12:39 PM

Unfortunately many women have both an epidural in labour and then a spinal if a C/S is needed and that will mean two separate item numbers.
I understand the fact that your epidural didn't work would make it really difficult to cough up the money for it but the equipment and the drugs involved are pretty costly. It would be nice however if your anaesthetist could show some empathy and lower his/her fees and I would actually approach him/her and try to negotiate these.

What I would probably do is send in the two cheques from Medicare and Medibank with an accompanying letter asking for an explanation of the costs and whether there is any room for 'movement'. Some will show compassion but it is well known that the anaesthetist bill is often the biggest in obstetrics.
What you have got back as rebate does sound about right but they will only rebate you on the scheduled fee so if the anaesthetist ups his charges you will be more out of pocket.

I know this is cold comfort Lokum but my anaesthetist 30 years ago for my eldest DD left me $900 out of pocket and that was a huge amount of money back then. It seems nothing changes.

Hope they will be kind, do not be afraid to ask for a discount or at least a payment plan.
Good luck.

#8 Lokum

Posted 15 February 2013 - 12:40 PM

Thanks everyone. It is as I thought  sad.gif .

Bad luck that I was scheduled for a c/s but he decided to come early and I ended up with night time emerg c/s... I believe the anaesthetist I would have had for the scheduled c/s would have been no-gap.

Bad luck also that I had an epi AND a spinal, and double the hit to my pocket sad.gif

You don't really budget for that scenario. Lucky the baby is absolutely lovely, and very healthy  biggrin.gif

#9 Lainskii

Posted 16 February 2013 - 07:57 AM

I was annoyed as I had a planned CS due to issues and the day before the anaesthists secretary rag and said it the bill would be approx $800, when it came it was $1400. My op didn't take any longer than normal and had no issues.

#10 ednaboo

Posted 16 February 2013 - 08:11 AM

You should at least be able to claim a tax rebate for this under "medical expenses over $2060".  ATO.

#11 barrington

Posted 16 February 2013 - 08:21 AM

That sucks OP!  Most anaesthetists I know would only bill you an out of pocket for the first procedure.

For anyone that is interested, here is a link to a page explaining how private anaesthetic fees are calculated.

And for a PP - anaesthetic fees are calculated on a time basis.  So if your operation did take longer than your estimate was based on, then your fee would be higher.



#12 Soontobegran

Posted 16 February 2013 - 08:29 AM

QUOTE (barrington @ 16/02/2013, 09:21 AM) <{POST_SNAPBACK}>
That sucks OP!  Most anaesthetists I know would only bill you an out of pocket for the first procedure.

For anyone that is interested, here is a link to a page explaining how private anaesthetic fees are calculated.

And for a PP - anaesthetic fees are calculated on a time basis.  So if your operation did take longer than your estimate was based on, then your fee would be higher.


You are lucky barrington, I admit to not knowing too many that will do that original.gif

The problem with this is that the anaesthetist will put their own dollar value on top of the AMA value and since the AMA value is more than the scheduled fee value and this leave an enormous gap for so many.

#13 IsolaBella

Posted 16 February 2013 - 09:33 AM

QUOTE (ednaboo @ 16/02/2013, 09:11 AM) <{POST_SNAPBACK}>
You should at least be able to claim a tax rebate for this under "medical expenses over $2060".  ATO.


The threshold has increased to $5k for 2012/13



#14 tibs

Posted 16 February 2013 - 09:51 AM

If it makes you fee any better I had a straightforward 30 min scheduled c-sec and had an OOP anaesthetist bill around that size and that was just for the spinal.  I had a different anaesthetist for my second scheduled c-sec and only had approx $500 OOP bill.  I had no OOP charge at all with my 3rd scheduled c-sec.  All 3 with the same Ob, same private hospital, all scheduled.  That was the only bill I had, Ob, assisting Ob and hospital were all covered.

#15 ednaboo

Posted 16 February 2013 - 10:26 AM

QUOTE (lsolaBella @ 16/02/2013, 10:33 AM) <{POST_SNAPBACK}>
The threshold has increased to $5k for 2012/13

Only for high incomes - $168,000 for couples apparently.

#16 Lokum

Posted 16 February 2013 - 11:42 PM

QUOTE (ednaboo @ 16/02/2013, 09:11 AM) <{POST_SNAPBACK}>
You should at least be able to claim a tax rebate for this under "medical expenses over $2060".  ATO.


Yeah. Another sucky thing is that we had huge OOP in 2012 because of IVF early in the year, then obstetric and anaesthetic! fees later in the year - total around $7500.

However, these were split over the 2011-12 and 2012-13 financial years, so we'll have to meet the threshold for the tax rebate in each financial year before we can claim, and we'll probably get 75 cents or something back...

I know there are worse problems to have, but gahhh!

#17 Wildence

Posted 17 February 2013 - 12:09 AM

QUOTE (Lokum @ 15/02/2013, 01:40 PM) <{POST_SNAPBACK}>
Lucky the baby is absolutely lovely, and very healthy  biggrin.gif

I was just going to say that! Thank god to a healthy baby original.gif

I had to do D&C one year ago, and ended up 1k OOP for such a small and common procedure, i can totally see how frustrating it is that you have to pay that much! However at least you have a healthy baby in your arms as a result of that.


#18 tibs

Posted 17 February 2013 - 09:58 AM

QUOTE (Wildence @ 17/02/2013, 01:09 AM) <{POST_SNAPBACK}>
I was just going to say that! Thank god to a healthy baby original.gif

I had to do D&C one year ago, and ended up 1k OOP for such a small and common procedure, i can totally see how frustrating it is that you have to pay that much! However at least you have a healthy baby in your arms as a result of that.


Yes same, I was actually more OOP for the D&C before my last pregnancy than I was for my last birth (scheduled c-sec).  And no baby to take the sting out of it sad.gif  Now that sucks.




1 user(s) are reading this topic

0 members, 1 guests, 0 anonymous users

 

How a pregnancy contract could work for you and your partner

The idea of making a 'pregnancy contract' with your partner may sound a bit silly at first, but it can help make the transition to parenthood a lot smoother.

Finding a mum-friendly personal trainer

Burping babies vs burpees – yes, new mums and personal trainers live in different worlds. But they can work together - once you find the right match for you and your lifestyle.

Ambulance service under fire: baby seats to go, response times 'worse than ever'

The NSW Ambulance Service is removing child-safety seats from ambulances, while the Victorian service is facing criticism over lengthy response times following the death of a three-year-old.

Alleged baby snatch incident a ?misunderstanding?, say police

Police say that an incident in which a man pulled on a woman?s pram while walking a popular Sydney route late last month was a misunderstanding.

Ebola killed my aunt and is shutting down my country

Three weeks ago, my auntie, a midwife, developed a fever. Sitting here in Sydney basked in Australian sunshine, that shouldn't be big news.

The night my ovary burst

One mum shares her frightening experience and vows to never take her health for granted again.

Is e-reading to your toddler story time or just screen time?

When reading increasingly means swiping pages on a device, and we're advised to read to their children early and often, should parents be turning to e-readers for storytime?

Community mourns inspiring young dad

A young dad who fought a five-year battle with cancer has been remembered for his inspiring legacy at a funeral service attended by hundreds of family and friends this week.

Meningococcal kills Queensland toddler

Public health authorities say the death of a toddler in north Queensland from meningococcal disease highlights the danger the illness poses.

Nicole Kidman: 'I hope every month that I'm pregnant'

Nicole Kidman is hoping to add to her family, but says she's doubtful it will happen.

Recall: Aldi Wooden London Bus play set

Aldi has announced a recall of their popular Wooden London Bus play set.

Great gift ideas for first birthdays

From soft toys to balance bikes, here are some great ideas for first birthday gifts.

Mum learnt she was pregnant hours before giving birth

Kim Walsh arrived at the doctor with abdominal cramps. Hours later, she was cradling the baby experts told her she could never have.

How cancer has made me a better, happier person

I'm a far better person post-cancer than I ever was before. The goal now is to stay around long enough to find out who I can become, and what I can achieve.

Pete Evans says a paleo diet can prevent autism. He's wrong

Pete Evans is not a paediatrician or even a nutritionist or dietitian. So why should we believe his extreme views and remove food groups from our children's diets over the advice from those more qualified?

Let's get back to commonsense parenting

Forget the new 'Lawnmower' parenting trend; try using plain old-fashioned commonsense instead.

Woman sues after having a mixed-race baby

A US woman is suing a sperm bank after it sent her vials from African-American man, instead of the white donor she had selected.

Bonding ideas dad will love

Dad may not say it, but he could be feeling lost, confused and seriously left out. However, there are lots of things new fathers can do to be more included in the excitement of pregnancy and new parenthood.

The house that hope built for childhood cancer

Baby Laelani Baker was diagnosed with cancer before she was even born. Her heartbreaking story is just one of the reasons the Build for a Cure project is raising money for vital research into childhood cancer.

Does stay-at-home parenting get better?

Parenting doesn’t ever get easier; the challenges just change. But the challenges of caring for young children definitely lessens as they get older.

Inquest into the short and tragic life of Chloe Valentine

As the first phase of an inquest into the death of Chloe Valentine drew to a close, there was no doubt Chloe's life was marred by appalling neglect.

When mothers kill

The act of killing one's child is unthinkable for most, and a mother who kills her offspring has a special power to inspire shock and revulsion.

6 beauty tips for tired mums

For those of us with young children, eight hours sleep is a distant memory. And while we can’t do much to secure more shut-eye, there are some ways to fake it.

Download now: Essential Kids Activity Finder app

Got bored kids? Quickly find the best activities for kids wherever you are in Australia with the Essential Kids app.

 
Advertisement
 
Advertisement
 
 
 

What's hot on EB

16 parenting truths you won't find in the baby books

I am five years into this parenting gig and I’ve learnt that sleepless nights and changing dirty nappies are child’s play.

Win 1 of 5 Canon Powershot D30 cameras

Capture life more easily with the Canon Powershot D30. Shockproof, waterproof and dustproof, you can take it almost anywhere and shoot beautiful images, time after time. Enter now!

Best and worst potty party cakes

It's nice to celebrate a child making the shift from nappies to 'big kid' undies, but do we really need a semi-realistic used toilet cake to do it? Here are some of the best and worst cakes parents have used at 'potty parties' around the world.

7 tips for a financially festive Christmas

Plan ahead - and do it now - to ensure festive season expenses don't break the bank.

'Go the F*** to Sleep' author's new book for frustrated parents

A sequel is coming soon to the 2011 hit book 'Go the F*** to Sleep' - and this time, it's about mealtimes.

Great birthday party buys from Etsy

Handmade crafts to decorate and personalise your child's next birthday - from banners to cake decorations, we've got gorgeous party finds from Etsy.

Creative storage ideas for the kids' rooms

Creative and practical storage ideas for the kids' toys and books can also add some stylish decor to your home. Visit babyology.com.au for more stylish modern finds for hip kids & parents.

Awkward grandparents

When Grandma and Grandpa pose for a snap with the kids, things can get very weird, very quickly.

To the mum in the doctor's waiting room

Maybe the mum I saw in that waiting room, seemingly disconnected from her baby, doesn’t have the support she needs.

10 space-saving nursery ideas

Starting a family doesn't always mean moving into a bigger house - not yet, anyway.

 

What's in a name?

Baby Names

Looking for a classic name, or an unusual name? Our Baby Name Finder is for you, search or browse to refine your shortlist.

 
Advertisement
 
 
Essential Baby and Essential Kids is the place to find parenting information and parenting support relating to conception, pregnancy, birth, babies, toddlers, kids, maternity, family budgeting, family travel, nutrition and wellbeing, family entertainment, kids entertainment, tips for the family home, child-friendly recipes and parenting. Try our pregnancy due date calculator to determine your due date, or our ovulation calculator to predict ovulation and your fertile period. Our pregnancy week by week guide shows your baby's stages of development. Access our very active mum's discussion groups in the Essential Baby forums or the Essential Kids forums to talk to mums about conception, pregnancy, birth, babies, toddlers, kids and parenting lifestyle. Essential Baby also offers a baby names database of more than 22,000 baby names, popular baby names, boys' names, girls' names and baby names advice in our baby names forum. Essential Kids features a range of free printable worksheets for kids from preschool years through to primary school years. For the latest baby clothes, maternity clothes, maternity accessories, toddler products, kids toys and kids clothing, breastfeeding and other parenting resources, check out Essential Baby and Essential Kids.