Private OB's and out of pocket costs with Medicare

[millsy81]

Hi All,
Does anyone know how it works with private Ob's and claiming back out of pocket expenses.
We are looking at TTC for # 2 in the next few months and the OB we are looking at (Dr John Regan Jesse Mac ) charges $4,800 for pregnancy care.
It used to be that once you reached your medicare safety net threshold you would then get 80% back of your out of pocket expenses.
Is this still the case?
I also have private health insurance, but don't think that matters so much with private ob's.

Any advice would be great,
Kate

[Rach83]

From memory nearly 2 years ago, I found that private health only fully covered my hospital stay and some of the anaesthetist and OB larger charges -not much though) The rest was Medicare.


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[glenny_c]

What does the 4800 include? Is it all appointments, scans and management fee? Or do you still have to pay for your appointments?

I see a private OB and pay per appointment. I think it's $80 per appointment but before I hit the safety I was getting back $40 . Now we have hit it, I will get 80% back. Refunds for scans and management fee have been capped. My management fee was 1400 and I only got back $479. I think it's capped at $500. So no matter what your management fee is, you'll only get back 500. You don't get much back for scans either. But my OB does my scans so it may be different if you are going to a scan place.

I have no charge for the hospital part of the pregnancy/birth as I have PHI which covers that.

You'll have to find out how the $4800 is split up as different parts of it will attract different refunds.

[teresa]

my private ob with private insurance wasnt much really. appointments were $55 and i got $30 back per appointment from medicare, then after 20 weeks i got charged $1400 which i got $500 back from medicare. i cant comment too much on anaethetists or in hospital as i ended up in a public hospital so it was only my ob that charged which all fees were covered by private health. all i had to pay was the hospital excess. the paediatrician and anaethetist were public so medicare paid that.

imo i say its very well worth it. but then again i had a very complicated pregnancy and i liked having my ob just a phone call away if i was ever concerned or worried.

have a chat with the receptionist at the ob's office and they will give you a run down of all the fees and what they are for

[sunshine 11]

Mine charges $3400 for pregnancy care, and all I will get back is the capped rebate, around $500, nothing more, so if your OB charges more than that, you still only get the capped rebate - not the 80% like I did for my first pregnancy and what you get for almost any other type of medical care covererd by Medicare. IVF and OB fees now have capped rebates.

Hospital costs are minimal, just the excess if you have one - the anaethetist cost had no gap, but not all of them are the same. The one for my DD did have gap fees of a couple of hundred dollars. OB fees can very very expensive, Medicare capped the fees as they felt that OB were charging way too much, which given some of the differences in how much they charge probably justifies I guess why Medicare capped it ( not that it stops me from seeing mine, he's great).

[AndiE]

I was told by Medicare just 6 weeks ago that the rebate for the pregnancy management fee is capped at $480 (approx) regardless of the fee charged. X-ray fees for pregnancy are also capped, regardless of whether you've hit the threshold also.

For these reasons, we're going public with this bub, despite two previous great private experiences. Would rather have that money AFTER the baby is born. Makes me think the baby bonus etc should be somehow redirected to cope with pregnancy management costs. But I guess that's another debate entirely.

[Elocin]

I see a private Ob and his Pregnancy Management Fee was $1500 of which I got $479 back from Medicare, nothing from PHI. Each appt costs me $40 (which includes a scan), of which I get about $39 back through Medicare even though I haven't hit the threshold.

As Glenny said above, the amount of $500ish back from the the Ob fee seems to be standard no matter how much you pay.

After we did IVF last year, we hit the threshold and we were getting 80% back from GP appts etc through Medicare.

You're right though, PHI doesn't impact on the fact that you are seeing a private Ob... it seems to only help with the hospital fees (usually paying the excess only of admittance). Mine didn't help a great deal with the anaethetist fees when I had my laparoscopy. From memory, I paid about $700 up front and got about $200 back from Medicare and about $50 back from PHI... I shouldn't complain, because at least I got something back!

[LuluHB]

What Glenny says - unfortunately. My OB's management fee is $2,700 and he charges about $160 per appointment, but only charges for some appointments (initial few before the management fee kicks in) so even with the threshold I'll be out of pocket heaps. He does have no gap coverage with the PHI I have once we actually get to birth and hospital though so I guess that's something.

I have noticed this pregnancy that Medicare has capped a lot more scans and procedures than when I had my DDs a few years ago.

[Ahurani]

Millsy: look around at other obs there are cheaper ones out there. But I have heard John Regan is amazing.

All my ob appts are bulk billed. I have 2 management fees. 1 at 20w and one at 30w. Ultrasounds are extra etc. The other girls have summed it up well. If you want the name of my ob (I think he delivers at Jesse Mac) pm me.

Going private is so expensive. But imo has been worth it so far. I feel better taken care of.

[emmjayt]

My OBs management fee is $6000, and so far totally worth it. No appointment fees though. We were only supposed to get $480 back from Medicare, but when I went to claim they said we'd hit the second Medicare threshold and we got $560 back instead.

[Miss E]

Short answer is not much.

- I pay $80 a visit and get about $40 back (I had hit the safety net last year though so was getting more, but now with the new year I'm back to the $40).
- 20 week management fee was $3800 - got back $480 from medicare.
- get the schedule fee back on scans and bloods etc (regardless of where we are on safety net) which has been about 50%

I'm 31 weeks and ATM am up to about $4200 in out of pocket expenses. By the time bubs arrives I'm expecting to be well and truly over $5000 (but I am having a CS so will have anaesthetist and pediatrician in there as well).

But come tax time, I understand that I can expect to get about 20% of medical expenses back when I do my tax return.

So at the end of the day we expect to finish up somewhere between $4000 and $4500 out of pocket. Lucky we're not planning on having 10 children!

[millsy81]

Hey girls,

Thanks so much...
He is an expensive ob, however i will be trying for a vbac with a private IM and she will do shared care with John and he's had lotsa great reviews.
Knew we woud be up for big $$...he is expensive though.

I'm all new to this Belly belly thing...how do i private message someone??

Cheers girls,
Kate

[Ladylove]

I get about half back from each visit with my OB (through Medicare - none through health insurance as it is not an in-hospital cost). We are fully covered by our insurance for all aspects of the hospital stay except for some of the anethecist costs if I end up with an epidural or need an anaesthetic of some kind.

[Strawberry55]

I'm all new to this Belly belly thing...how do i private message someone??

I'm new here as well and have just found out you need to get your post count to 50 before you can privately msg someone and not have to do an image verification before you post

[EsJay]

Millsy, my ob's management fee is $2000, medicare have advised me that as at 1 jan the refund is now capped at $469 for this, i am about to go claim it so will know for sure if this is the amount. but it will make me hit the safety net again, and get good amounts back for anything else this year. my ob doesnt charge a visit fee, she just bills strait to medicare the amount they will cover ($32.80 i think that is). she also does scans in her office, however the 12 and 20week scan she sent me to a specialist for this it cost me $210 each time and only $60 back from medicare. My private insurance covers the hospital stay, aneasthetist etc. peadiatrician is on top and get back whatever medicare give From memory it was $180 and i got back $90 with DD. A lot of things with medicare are now capped as the gov is broke, 2 yrs ago when i had my DD i got $1200 of the $2000 back, so i was quite surprised when the lady at medicare said your looking at $469 refund.

Miss E what exactly were you able to claim, i have heard people say this, but when i asked my accountant after i had DD he said there is nothing you can claim for medical expenses and he'd never heard of anyone doing so. Hes a good accountant and i trust him, i didnt question this, but have been curious as to what exactly you are able to claim, and then i maybe able to raise it with him again this time round.

[emmjayt]

Hi Jen, once you've hit more than $1250 (I think) in medical expenses you are entitled to 20%(I think) of it reducing your taxable income. From memory you can claim the whole household on your highest income earner - that's what we do, and it was a blessing with IVF last year and now with bub due in May will help this year too

[glenny_c]

It has been increased to $2000 now. So you get 20% back of every out of pocket dollar AFTER $2000. You don't get anything back from the intial $2000.

[sunshine 11]

Jen - the medical expenses tax rebate is one of the standard rebates available to everyone. As it's a rebate, not a deduction this means that as long as you owe tax, you can get 20% of ever dollar back over $2000 out of pocket (up from $1500 last year) - the pooled total medical expenses for anyone in your family, including children up to 21 (and more - see link below).

This means that you don't need to put it under your hightest income earner as it's not a deduction (which is where the higher the marginal tax rate, the better the return). As long as you owe more tax than you are owed for the rebate, you can put it under your own tax, but include your familys medical costs. Without wanting to be harsh, your accountant isn't doing a good job by not knowing about this, but most people luckily don't go anywhere near this limit.

Remember, it's not just for Medicare claimable expenses, it's also for things like glasses, prescriptions and physios if you are referred by a doctor.

Have a look here:
T9 - 20% tax offset on net medical expenses over the threshold amount