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Costs - how does it work?
obstetrician, hospital and safety net

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#1 MrsAx

Posted 26 April 2012 - 11:13 AM

Im so confused about the costs.  Here is what I know, let me know what else i need to know.  
1. You have appointments with your private obs, which are out of pocket, Im guessing you have say 5-10 of these and they might be $50 - $150 each
2. You pay a management fee to the obs which for me is $4,000
3. Im not sure what medicare reimburses
4. how does the safety net work - is that just out of pocket costs for out of hospital in a calendar year? do you get everything back after $1198? does the obs visits and management fee count towards this?
5. once in hospital, you pay your private health insurance excess only

#2 Melissam12

Posted 26 April 2012 - 11:15 AM

You'll probably have 10-14 appointments with your ob.

#3 NotBitzerMaloney

Posted 26 April 2012 - 11:24 AM

1. Appointments - mine are $100 and I get about $40-60 back. The number you have depends on how your pregnancy progresses. Second time around I basically asked for minimum number of appointments (ie most people are going fortnightly or weekly at this stage, I'm every 3 weeks)
2. Same. Of this I got $460 back from Medicare
3. As per 1&2
4. The amount you get back after you reach the safety net is different for obstetrics than other items. Basically.... Just presume there isn't one and you might be pleasantly surprised to get a few $$ back.

Hospital costs - you may have to pay your private health insurance excess and another "out of pocket" costs (my hospital it was another few hundred dollars.

5. OTHER: You may be up for other costs. Some OBs charge extra for an emergency c/s (e.g. An additional $1-2k), anesthetist costs are extra (Anywhere from nothing to $1k-4k), you may have a pediatrician visit your child ($200?) esp if a c/s.

Call your OB's office and get them to talk you through it all

Edited by NotBitzerMaloney, 26 April 2012 - 11:26 AM.

#4 ~Nic~

Posted 26 April 2012 - 11:36 AM

1. I had 10 appointments with my ob, starting at 12 weeks I went ever 4 weeks, then when I got to 32 weeks, I went fortnightly and then weekly from around 38 weeks. My ob didn't charge anything out of pocket for the check ups, but some obs do. You will get around $35 per visit back from medicare (health funds can't pay on dr's outside of hosp, so it's just medicare), so the amount you pay will depend on what your ob charges.

2. Yep, you pay the management fee to the ob, $4000 seems to be the average for metro areas.

3. You will get some of that back from medicare, but I think it's only in the ball park of around $400. Don't forget that you spend over $2000 in medical expenses (including things like doctors fees, dentist, physio etc, but not including your hospital excess from your health fund) you can claim a portion back on your tax.. it's around 20% of what you pay after the first $2000. Look into the medical expenses tax offset.

4. Safety net only applies to outpatient services, so things like you checks ups and scans with the ob, and also things like visits with your GP or blood tests at the pathologist. Not sure about how the management fee works with it now... when I had my kids, it was counted, but I have a feeling that has all changed. Best bet is to call medicare on 132011.

5. Check that the hospital you are going to has an agreement with your health fund. I work for a health fund and have had people claim on the hospital bills, only to find out that the hospital doesn't have an agreement with the fund, so the fund can't pay the whole bill. Call your fund to find out. As long as the fund has an agreement with your hospital and as long as you have cover as a private patient in a private hosp for pregnancy, you shouldn't have anything else to pay for yourself. (Bear in mind - hospital bills only include things like private room accomodation, theatre fees / delivery suite, medication, meals for yourself etc. Your ob's delivery fee is not included in the hospital bill - it's a seperate bill that you can claim back through both medicare and your PHI. Check with your ob and ask if you will have any out of pocket expenses for the delivery fee). If your partner stays in hospital with you at any point though, the hospital will probably charge a boarders fee for him and that isn't claimable.

Also remember that if everything goes according to plan, bub will probably "room in" with you - they will be put in one of the plastic cribs in your room. This means that bub is classed as a boarder, not an inpatient, so you can't claim and doctors bills for bub. Only bill you should get though is the peadeatrician who will check bub out before you go home, and that's claimable on medicare only. If however the dr decides that bub needs a little more attention, and they decide to admit bub in to NICU or special care nursery, you need to call you fund STRAIGHT AWAY and get them added on to your cover. Your fund should offer continuity, which means any waiting period you have served, you bub will have served as well. So, as long as you have served all of your wait's, but will be covered from birth. If that's the case, bub's accomodation, theatre fees and dr's fees should be claimable through your fund and medicare (medicare won't pay on private hosp bills though, only the doctors).

Best bet from here - call your fund, make sure the hospital has an agreement with them. Also ask when you need to upgrade to family cover (some funds make you do it before bub's born). Call your ob, ask if there are any out of pocket expenses for the delivery fee and how much each of the visits will be and what the item number is for the visits. Then call medicare, give them the item number and ask how much you will get back on your visits and ask about the pregnancy management fee and if that counts towards safety net.

Good luck!

#5 Melissam12

Posted 26 April 2012 - 11:44 AM

You're also out of pocket for scans and pathology.

#6 Melissam12

Posted 26 April 2012 - 11:47 AM

The govt has essentially cut the benefits that you can claim for obstetrics, and at the same time, has introduced generous benefits for private midwifery care.  There are options in Sydney, QLD and possibly Melbourne and WA where you can birth in hospital with your private midwife, with obstetric back-up.  This is cheaper (on average) than private obstetric care as the benefits are more generous for private midwifery than private obstetrics.

#7 jess1980

Posted 26 April 2012 - 05:51 PM

Omg I never realized how expensive it all is! All I've ever had to pay for my first daughter was $55 per drs appt, same with the second. This time I'm going to a specialist and it's $70 per appt. I'm going private in a public hospital and there's no gap between what Medicare and my private health covers thank god I wouldn't be able to afford all that

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