Private obstetrician & medicare safety net

[LionsandBears]

Can someone please explain how medicare works with private obstetrician fees. I'm just researching things atm, umming and aahing between public, private and homebirth.

How much can you claim back? I have a quote for a top notch OB in Melb. What would be our out-of-pocket?
1st appt inc scan: $285
20 wk mgmt fee: $2600
30 wk mgmt fee: $4400

birth covered between medicare and PHI.
Total cost: $7,285

If we ended up with a c/s, would anaesthetist be covered by medicare/PHI or would there be extra?

I may be considered 'high risk' so want someone I can go running to when I'm freaking out or if the next bub also ends up being sick or dies. It's mostly for pregnancy management. Birth doesn't worry me unless there's a medical problem.

TIA

[Nai]

Tashy - you need to ask them what the Gap is? That will tell you how much out of pocket. With a C/S you are covered with PHI and only pay the excess eg. I had a $500 excess on my PHI and everything else (except for the Wifi and the take home drugs) was covered by the PHI. Some anaesthetists and support OB's send invoices too but they are generally completely or mostly covered by Medicare as well.

The paed is medicare so you only get some of that back - I think I was $50 out of pocket.

[LionsandBears]

Thanks Nai - I called back and asked. I didn't want to look silly, but meh

Apparently the first appt I get $100 back from medicare. Nothing back on the 20wk payment, $500 on the 30wk payment. The remainder of the total is claimable on tax. So total out of pocket is $6,685.

I'm trying to work out if it would be worth it.

On top of this, we'll be needing a lot more scans, which we prefer to get a private OB sonography specialist to do. We'd be able to get a lot back from those through medicare (about half I think).

We have a $500 excess on PHI as well.

[MamaPan]

It also depends on when you hit the medicare safety net - with both boys i hardly ended up out of pocket as we hit the safety net and got 80% back on medicare.
the gap is the diff b/n the standard medicare rate and the private rate - but that is what you get when you are UNDER the safety net (i think).

you could also call medicare and ask them how it work with the safety net (it is confusing)

[M D]

Tashybabe - that seems expensive compared to mine.

1 st appt + scan -$240 about $80 ish back
subsequent appoint's (monthly to 30 wks, then fn to 36 then wkly) - $140 medicare $38.55 each appt (capped at 10 appts then $40 each appt)
Pregnancy management fee - $1700 and I only get about $450 back on that.

He then charges a delivery fee which is what ever my PHI will give him there is no gap for this one.

For my admission to hospital I just have my excess which is $300 payable once only.
If I have a epidural that is an extra $500 ish dollars with partial claimable on my PHI and medicare.

I thought my Ob was expensive but he is well worth it. With my DD my pregancy was text book with no troubles but I needed the reasuring and the straight talking from him so he was worth every cent.

This time around we don't have the extra money we did but once I saw my Ob for the first appt I was 150% satisified we had to find themoeny for him. Your mental health plays such an important roll for your pg and after care.

If spending the money on your Ob is what you feel is best for you then thats what you should do. Don't let anyone tell you they went another option and that you should do the same, you do what feels best for you.

[HotI]

My pregnancy was 'high risk' just based on the potential for issues due to my medical condition, going public was better because many unexpected extras were covered without extra costs. I was able to get care during pregnancy when there were issues, but not with the same carer each time. Next time i'm going with an independent midwife. I would recommend an IM over an Ob.

[Miss E]

I don't think the Medicare Safety Net applies to obstetrics anymore... but I could be wrong...

For me I ended up having to have an emergency CS and I did get a bill from the anaethsist (sp?), from memory it was about $400 - $500 and that was after medicare and PHI.

The first OB I saw was very expensive, I was going to be out of pocket about $6,000 for his fees alone (and that was with the Safety Net). I spoke to a few people and rang around to find someone else who could fit me in, then got another referral from my doctor for a different OB (who I ended up loving) and we ended only being out of pocket about $3,500 (with the safety net) for his fees, then there were scans, blood tests and the PHI gap, so all up were out about $5,000. His offices were in Clayton and weren't nearly as fancy as the first one whose offices were at the Freemasons, but I found him much more personable, very passionate about childbirth and very supportive and encouraging of my wish to have a natural birth. Happy to PM you his details if you're interested. I guess what I'm saying is OB's pricing is very different, but I think like any business a lot of it has to do with where they're located and the costs they have of having their offices, rather than just their experience iykwim?

[MamaPan]

yep i would agree w what Miss E said re the diff obs, go with someone who you gel with and who has good references... (assuming you have chosen someone you are comf with). the fees do vary a lot and some of them are kind of 'trendy'... but may not be the person you want... (or may be and thats why they are popular).
i wasnt sure if the medicare safety net thing changed (it was all changing aruond when DS2 was born)

[LionsandBears]

Thanks Kate. That's reassuring.

I have a thread about public too: https://www.bellybelly.com.au/forums...d.php?t=154153

We'll still have our IM, it would just be for birth instead of the whole pregnancy. TBH, I'd prefer just our IM. She's great, she knows our history, we have hour long appts in our living room which DH can attend without taking time off work. It was her advocacy that meant we ended up with a vaginal breech and not a c/s.

It's for the just-in-case scenario. Just in case we have a m/c, what happens if you're in the public system and need a D&C? Just in case bub is sick, does a private OB make any difference?
If I want/need inducing or a c/s, what's the difference between private and public? The main benefit I can see is continuity of care. We were lucky with the last bub to get a consultant who can do vaginal breech. That may not happen again.

Aargh - it's all doing my head in. Why can't you engage an IM for everything and just call in an OB when it's needed?

[Miss E]

We'll still have our IM, it would just be for birth instead of the whole pregnancy. TBH, I'd prefer just our IM. She's great, she knows our history, we have hour long appts in our living room which DH can attend without taking time off work. It was her advocacy that meant we ended up with a vaginal breech and not a c/s.

It's for the just-in-case scenario. Just in case we have a m/c, what happens if you're in the public system and need a D&C? Just in case bub is sick, does a private OB make any difference?
If I want/need inducing or a c/s, what's the difference between private and public? The main benefit I can see is continuity of care. We were lucky with the last bub to get a consultant who can do vaginal breech. That may not happen again.

Aargh - it's all doing my head in. Why can't you engage an IM for everything and just call in an OB when it's needed?

For me it was continuity of care, the fact that I could stay in hospital for longer and get more help with breastfeeding and that DH could stay with us, that made it worth the money. And I have to say after having a CS, it was great to have DH with us cos he was able to care for DS that first night while I was still bed ridden.

I have a friend who had a very similar labour and emergency CS to me in a public hospital. She had to wait 5 hours for her epidural after she'd requested it because the aneathisist wasn't available and ended up having 2 shots of pethidine in the meantime. I had my epidural being administered within 20 mins of asking for it in the Private hospital. Also, because her DH couldn't stay with them the first night, her little girl had to spend her first night in the nursery simply because she was bed ridden and couldn't care for her.

That said, I think our public system is very good and I'm not sure if I will be willing to fork out the money for private next time around... If you have an IM and go public you will be able to just call in an OB when it is needed, it's just you won't necessarily get to choose which one iykwim?

HTH

[Junglemum]

My OB rocks. I seriously love him. He listens, he's compassionate, he is not at all arrogant, he let's you have a say, he has supported all my decisions and let me birth how I want. Yes he'll discuss it with me, but the end decision is mine. Sure he barracks for collingwood but we all have our downfalls!

My out if pocket is $3000 plus $400 hospital excess. That covers everything. But that's bc the hospital I go to have a deal with my PHI that you have no other expenses. So it will depend on your PHI and hospital.

[ezymay]

I went private with dd but have gone public this time. I couldn't justify the expense now the rebate has changed. You def only get back a small amount from your management fee from Medicare no matter if you get to the safetynet or not.
If your baby is sick they will get care no matter if you are private or public. Most private hossies have small SCN and often can't take babies below a certain gestation (where I had dd it was 36 weeks) so they sometimes go to the public hospitals anyway.
Saying that tho I'm not going to my local public hospital cause their system of general ante natal care isn't great,(no appointment time, busy clinic etc) so am going a bit further out and doing shared care. I'm not high risk tho, if I was I'd consider going back to my ob.
A gf of mine was high had all her appointments, scans etc thru the public fetal maternal unit which was the best place for her because they only deal with high risk so see it all so to speak.
Public it is harder to ask for inductions and c/s, they make you work for it a little bit. That is the advantage of going private.
You have to feel comfortable with whatever you decide..good luck

[*Beema*]

I went with my private OB and while I didn't get as much back this time I still wasn't too badly OOP because my OB rocks (she is a fantastic OB too )D) and has her fees set up really well and is a lot cheaper than anyone else.
I did work out how much it cost me but I was less than $1500 OOP.

My appointments each were about $85 and initially I got back $45, then when I passed the MSN I was only paying $14.55 OOP per appointment. My Management Fee was $1060.40, I had just passed the MSN the day before by a whopping $1.80
And I got back $463.40, which was $200 more than if I hadn't already passed the safety net. Because my OB has payments we make with each appointment, we get a lot more back from Medicare, and because I passed the MCSN before my "big" payment (which is small in comparrison to so many of you) I got an extra $200 back.

My OB also had her own US machine, she was able to do all of the growth scans, uterine dopplers, cervix lengths etc, she also had a CTG machine, so when I had monitoring I was able to do it in her rooms rather than hospital, I don't think they would have let me out again had I been in hospital I only had an early scan at the WCH, and then the 12 and 18-20 weeks scans at a high risk clinic, we got a bit back from MC but not a lot. Delivery was paid for for PHI, and I never received a bill for my anaethatist (C/S) and in the end had a $400 excess for my hospital stay because DH used up my bonus points a couple of weeks before hand as he had to go in for surgery. But we changed our cover and now we get 2 free hospital stays per family and DD2 was actually covered from birth so we had no excess for her SCN costs.

So I guess if you are going to be high risk I would also see what scans they can do in their offices for you, and what might be extra's

I had a thread about it all, which has some great replies in it Medicare Safety Net, EMSN and obstetrics fees ~ I am confused can anyone help?

I am astounded by how much everyone has to pay, my OB is so cheap ad she had even put her fees up, since DD1. It was a pity my meds weren't covered, the cost me a packet, over $250 a fortnight for Progesterone and Nifedipine... only a tiny bit covered by PHI
but for me it was worth every cent, I was on weekly appointments at the maximum, she took phone calls and sms's and was there for me the whole time, she is worth her weight in gold, and lucky I don't have to pay that much

The decision you make will be the right one, it is a lot of money.....

[Loula]

I loved having my private OB as i got to see him as many times as i wanted and i always saw him. he was even good enough to answer emails as silly as some of them were. My OB was also high risk and a great avocate for home births and VBACs. he believes there is no need for an OB unless it is high risk (i guess i was just high matiance after so many years of IVF and mc)

he was so compasionate and even came in on his day off to see how i was going. afer having terrible care in the private SCN he refered us straight into the public section (after NICU for three days) and even allowed me to stay an extra three days while DS was still in SCN.

I hated the hospital i was at but loved my OB so i am torn about going back, also as i would like a VBAC and he is very pro of these.

The cost is very expensive but looking back was well worth it for us, i had a beautiful labor but things got hairy at the end with losing bubs HR and it was only that my OB came in and gave me a CS with a GA that bubs got out in time, my MW care prior to that was terrible so i would also like a private mw next time (my SIL is a MW so i may have her)

I guess in answering your Q I dont remember getting much back but as i said well worth it for the care that i got during my PG, and i know OB would have supported HB.

I know that my CS was totally covered by PHI and DS stay in NICU/ SCN

please PM me if you would like to know the details of my OB as he is also in Melbourne

ETA i recall my OOPC to be abou $6000.

[Loula]

Why can't you engage an IM for everything and just call in an OB when it's needed?

Im sure my OB would be happy to do this