[Lokum]

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 )

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?

[bark]

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.

[Bluenomi]

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.

[MrsLexiK]

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

[Rach_V]

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.

This post has been edited by Rach_V: 15/02/2013, 12:35 PM

[lsolaBella]

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.

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.

[soontobegran]

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.

[Lokum]

Thanks everyone. It is as I thought .

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

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

[Lainskii]

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.

[ednaboo]

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