[mini-us]

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

[bluedragon]

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

[Wildence]

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!

[Jemstar]

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).

[mini-us]

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

[tibs]

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.

[Ella Minnow Pea]

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...

[bluedragon]

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.

[Wildence]

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.

[mummacat]

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.