Can someone decipher this for me?

I just emailed my insurance about what is covered and what isn't. I got this but don't understand what it means. Can someone explain it to me?


"Comprehensive Hospital cover will cover you for 100% of the government-scheduled fee for your medical bills and 100% of the hospital bills for all medically required procedures in an agreement private hospital.

This means that the labour ward and obstetrician will be covered. If you are on a family membership and your baby needs to be admitted into the hospital you will be required to pay a second excess. If your baby is not admitted into the hospital then your child will be billed as an outpatient as they will be regarded as a guest of yours. This will mean that any costs from a paediatrician that you incur will not be covered by Australian Unity but will be claimable from Medicare."

:-k :-k

Sorry all sounds double-Dutch to me! Can you call them and ask them to explain?

Gee that certainly couldn't have tried any harder to word that in a more difficult fashion now could they?

I think what they are trying to say is that they will pay 100% of the scheduled fee in a hospital that is in agreement with Australian Unity - remembering that the hospital most likely will charge over the scheduled fee, which means you may be out of pocket. So you probably need to take this into account when choosing your hospital. I would ask Australian Unity to confirm with you whether the hospital you wish to use is part of the agreement, or if they could provide you with a list of hospitals covered under the agreement. Then I would check with the hospital what the costs are so that you can try and work out what you would be up for (i.e. the out of pocket expenses).

WRT baby - the baby is not normally admitted to hospital when they are born. It is you that is admitted. If your baby falls ill and requires treatment, then they will be admitted to the hospital. So what they are saying is that if your baby is seen by a Paedeatrician, then they will not cover that cost because the baby is an outpatient, but you can take the bill to Medicare and claim some back through there. But if the baby is admitted to hospital, then you pay an additional excess, but you would then be covered by Australian Unity for the costs of Paed as the baby is an inpatient.

I think this is what they're saying! LOL

DGirl I had the same issue with my health fund :roll:

Basically they have told me that they will pay any difference between the Medicare schedule fee for hospital stay, some for my Ob etc and the baby is classified as a visitor. If the bub needs to be admitted to the special care ward then I would need family cover for 12 months, or I can go on single parent cover two months before I am due to give birth (which I might end up doing as it will be cheaper for the first couple of months and then DH can transfer).

If you are with MBF I can help you.

It doesn't make a lot of sense does it?!

Thanks everyone. That really helped me understand it.

I want to go to Francis Perry House and that is on their list of hospitals so I should be covered. I might just clarify that bit to make sure I am 100% covered.

Good to know that I don't have to pay for the baby unless he/she is sick and has to be admitted. That was a bit confusing.

OK then can I decide if he see's a paediatrician or not? Or can I send him next door to the royal womens?

DGirl - what they have said above is correct

To give you an example.

When I had my son the hospital I went to had an agreement and thus all my costs for the hospital stay itself, including meds, pathology in hospital etc. were covered - OBs anathetists, assistant surgeons etc can leave you out of pocket depending on what they charge.

My new son however got visited by paed every day for six days and had to have two lots of scans during that time - all of these were treated like an outpatient and thus not covered at all by private health fund

Hi I dont know if this is any help BUT,

We have just paid our OBGYN- Planning and management fee and it was $1250 this is a new out of cost expense to you when you go private, Also no the baby isnt covered but Hubby has been advised as soon as Baby is born to ring and place him on our cover so if anything is wrong he can be admitted straight away and will be covered. Also I know at my private hospital (sunnybank private) that the OBGYN just naturally gets a pediatrician to check the baby and it is then charged to you. We did get prior warning.

If you have any questions your OBGYN will be able to tell you what you can be charged and then what most people are covered for. If you have a major health insurer I guess?

Lindie

Hi!

It's all so confusing! Just one thing I wanted to bring up that stumped me with our fund is that there is a waiting period of 2 months before our baby was covered. I am covered for the birth and stuff but if by some chance the baby is early and has to be in NICU we have to have had a 'family' membership for 2 months so thats all paid for.
Just something to look into if you were going to get baby insurance, I'm sure not all of them do it but it would pay to find out! :p

I have family cover already. Well that's what I think I have :rolleyes: :shock:

Ahhh just go Public.
At least go on a tour through your public hospitals. You might find that some of them are just as nice as private. I had private cover with my first and I went around and compared hospitals and actually deciced that the public was nicer.

I was planning to go Public actually Sarah. Until I found out that a guy at works wife is a mid wife there so don't want to get found out before I am ready to tell. And the other public hospitals don't have maternity units anymore or they have very bad reputations or are to far to drive. But believe me I wanted to go public.

With public you normally dont go into the hospital for a midwife check-up till 2nd trimester...you just see your GP till then. And there is patient confidentiality so if you do get someone you know they are ethically obliged to keep their mouths shut ;)
Good luck either way Hon.

DGirl,
I was at FPH and what happened to me was your worst case scenario in what they have told you. I was admitted under a single coverage ( and paid a singles excess). If the bub is requiring a pead..which she did I could claim her under medicare but not PHI( this also includes BT or any other tests they may perform if bubs isn't admitted to the hospital), then she was admitted to SCN on day 6 so I paid another excess which brought the Excess up to what you would pay for a "family". But after she was admitted all peads bills could be claimed through both MC and PHI. PHI doesn't pay that much it is only the difference between 80% to 100% of the scheduled fee. The nurse in the SCN told me that MBP was one of a few that let you come in and change the membership once bubs was born
Bec

hi
did you know if you wanted to go public you can also see a ob and you don't have to pay as much money, also if you run into trouble wihist giving birth the hospital will call your ob to come in, i am doing this with my second and i have added up the cost and it will cost me around $400 after medicare. the only thing is that midwifes will deliver your baby.

I don't really want and OB though. That is my problem. I just want midwives and a private room.

Just found out that the woman I know is leaving work at thr RWH in two weeks, so I might just go there again.