Didnt make waiting period for health fund...

[happychild]

I'm very excited cos I THINK I'M PREGNANT (had two positive takehomes...waiting for checkup with GP now)

At the same time...I am a little nervous cos we have been blessed a bit earlier than we had intended. I only upgraded my insurance to a higher cover in July this year. If i am really pregnant, it means that my due date will prob be within the waiting period (drats!)

Does anyone know what this means? I know I'm not covered...but practically - how much more will I be paying? and what are my options now?

any tips will be appreciated. I am in Sydney if that helps! thanks!

[StrawberryTheMilkshake]

Maybe you could call your health fund, and if youve been a good customer for some time, they might waive the waiting list.

I dont know about costs or anything as i am in Brisbane and was covered, but maybe call around and see if you can the idea of costs?

Hope you find some answers and congratulations on your :bfp: :cloud9:

[HappyLittleChappy]

Before having my own bub, I worked in the privatehealth insurance industry.

It all depends on a few factors.

What health fund you are with - this determines how long their waiting period is as they aren't all standard.

How far along the pregnancy is - determines your due date.

If you are wanting to go privately for your bubs birth and you're not past the waiting periods, they won't waive them. They're quite strict as birth in a private hospital isn't cheap, especially if you need a C Section.

If you still want to go privately even though your insurnce won't pay - ask your OB and the hospital you will birth in for a quote. They are able to provide this as long as you aren't a high risk, although it will only be an estimate.

[meggs]

We had the same thing happen and my health fund told me I had to be covered for pregnancy 12mths BEFORE I even got pregnant so all they said I could claim was a private room in a public hospital though that isnt an option at my local hospital so basically I was covered for nothing even though I have had private health for nearly 10years it didnt matter.... I went through the Public system and cost me absolutely nothing even with a c sect and I had great care there was no way I was going to pay thousands I didnt have when i was already paying for private health!!!


Hope you have some better luck with it all!!

Congrats on your pregnancy too:)

[HappyLittleChappy]

Oh Meggs I'm guessing you're with MBF?
I'm pretty sure they're the only one with that stupid rule.

At the health fund I was with, we ALWAYS got people switching to us from MBF because of that ridiculou waiting period. They make you pay a family rate of cover while still a single or couple "in preparation" for the baby. It's stupid.

[meggs]

:no: not MBF but another major health fund...I didnt even think to change funds at the time I guess I would have expected to have waiting periods anyway .... obviously I have the cover now though but whether I even use it next time Im not sure....

[happychild]

yeh..i think most health funds has that rule. I remember ringing around to check before I upgraded it cos I knew i had to wait a bit. I'm with Medibank...and they definitley have this rule...annoying cos i've been a greate customer ALL MY LIFE...

oh well...it's a shame...but it still doesnt stop me from being really excited!!

Anyone know how much it costs to pay for private all my myself? might need to start saving =)

[HappyLittleChappy]

I worked for Medibank Private and there is no such rule with them.

You simply have to have a cover which includes pregnancy for at least 12 months before you give birth. This cover can be just you as a single person or you and your partner. You can fall pregnant within these 12 months as long as the babys due date falls outside of it. If you're on a cover which does not include pregnancy and you upgrade, you still must wait the full 12 months. Does this make sense?

If these rules weren't in place then people would join the lowest cover possible, then just a month before the baby is due change the cover higher to include pregnancy and expect the health insurer to pay out the thousands of dollars for the birth after you've only paid them a basic membership. The same goes for things like heart transplants etc. you can't expect to join a low cover (even if it is for 10 years) and have them pay for all the expensive treatments when they pop up. You get what you pay for.

With MBF you must pay a full FAMILY cover which is double a single cover, for 12 months prior to having the baby.

[happychild]

Hi Mummy2Phoenix.

That's the thing - I didnt have a cover that includes pregnancy before...and I only upgraded to the cover that included pregnancy 2.5 months ago (before that i was with the highest single cover that did NOT cover obstetrics).

I understand the reason for the rule =)...that's why I'm wondering how that will practically effect me (since I am within the 12 months and will only have my old cover that doesnt have obstetrics to fall back on).

Thanks for all your help girls...i might call Medibank private to confirm once i get a due date....

[Areca]

We had the same issue when I was pg with DD1. I just always assumed I'd go private and then we weren't covered (we'd only just signed up for PHI about three months before).

Anyway, I went public and went to a birth centre. I had a FANTASTIC experience! I'm so, so, so grateful that going private wasn't an option for me because it made me look at the choices I had and I realised that private wasn't even the way I wanted to go (but would have gone just assuming it was th ebest option for me because I was paying for it).

I have since cancelled the Obstetrics part of my PHI because I didn't want to pay for something I never plan on using. Hopefully it's a blessing in disguise for you too!

[Chootie]

I also had the exact same situation. We had upgraded our cover to include obstetrics, but fell pg a little faster than anticipated and were short of our waiting period (about 4 weeks we estimated). I was sure that the PHI company would be unsympathetic. BUT, they actually had a process in place for this kind of situation.

We had to get our GP to complete a form (called a certificate of attendance - or PEA form). Basically they wanted to establish that we werent pregnant at the time of increasing our cover. I submitted it and had a response in 2 days to say that they could see i wasnt pg at the time of increasing cover and they therefore would cover me for the whole thing. I even rang a few times to ensure i was not reading it incorrectly. Sadly for us, we miscarried so i didnt get to take them up on it, but i was determined to share the story as i think it is a well kept secret.

[Izy]

Mummy2pheonix
No- MBF doesn't have that rule at all.

You have to hold family supportive cover (including obstet) for 12mths at time of the admission to be covered.

And it's a bit silly to say you have to pay for a family when you are only a couple cause it's the same price. MBF doesn't charge for children added to a couple unless you are on ONE PRODUCT that doesn't even cover maternity anyway!

And a single can be covered for pregnancy and bith with MBF, but if you want your baby covered you need to pay for your baby in advance... they need to serve thier waiting periods too. I think it makes sense!

I work for MBF and we had lots of people changing from other funds cause of thier different rules too... What we percieve to be a change reason when a prospect comes into the branch or calls the number is not usually the full story. You may like to refresh your posts to remove any direct statement that demeans any other fund when you don't have the correct information. Your misinformation has the potential to upset many mums to be when it's nonsense and doesn't apply to most

[Areca]

Izy yes very true....I am covered by NRMA (who is basically MBF anyway) and we pay the same now...as a family of four, than what we did as a couple...well actually less cause we changed our plan a little bit.
When we had our girls we just had to ring up when they were born and bam, they were covered!

[miumiu28]

I'm not covered by health insurance as I didnt make the waiting period. So for now Im still on the single standard cover, couldnt be bothered to change to a higher level if I can't use it anyway.
So far I've spent $4000 for my ob, and $6600 for private hospital accomodation. Im still expecting invoices for the paediatrician, anastetic, etc. I hope that gives you an idea of how much you will be spending if you go private without insurance.
Not recommended tho..

[Babymills]

Just wanted to add my little story about health funds. I have been with my health fund for 9 years, but did not have obstetric cover. A month after I got married I called them to upgrade and added my husband to a family plan. A month after that we discovered we were expecting! I was sure that I would not be covered because I would have baby within the 12 month waiting period, but I called anyway, and politely put my case forward (focusing on the fact I'd been with them for a while and managed to recruit a new member via my husband). They graciously agreed to waive the waiting period. Happy ending!

Expecting February 2010!

[garfield13]

We had the same thing happen and I hunted around and found out that Latrobe Health only have a 9mths waiting period for obs. So I called up and changed to them - double checked that as I knew I was pg that it was still covered and it was, so I changed to them and all went wonderfully.
Funny thing was that when I called the fund I was with to cancel and explained why they said they would have matched it and covered me,, I had already signed up with the new fund and paid etc, so I just stuck with the change. But I would call your current fund and put this to thema nd see if they will cover you or move to Latrobe - when I looked in late 07 they were they only ones with a 9mth waiting period

[Jade1204]

Hi all

After reading all the stories of public v's private births, I am starting to think private health insurance is a load of bs. and a waste of money for a cushy private room.

My mum (who worked in this public hosp in Syd for 30 years) had 3 c-sections in a public hospital (I was an emergency c-section) and didn't pay a cent.

She reckons to change to the Ob you want all you have to do is find out what days they are "on" and tell the current ob you can't make it on his days any more, then re-book on the days the good ob is working.

So you still get the ob you want through your pregnancy, without paying private health insurance. Sneaky but good to know.

Now I just have to convince my hubby that it will cost us heaps more going private.

[Petersen]

Garfiled13 is correct, Latrobe's waiting period is 9 months. So glad I found this thread, as my husband and I are considering falling pregant with our first sometime in the near future so we are looking into private health cover. I emailed them today and received the following response :

Dear Sara,
Thank you for your enquiry.
The waiting period for obstetric related services is 9mths. The 9mth wait starts from the date that you join Latrobe Health Services.
I have arranged for a Latrobe Health Services brochure to be sent out to you and explains about all of the different levels of hospital cover and what is covered and also at the back of the brochure you will find a glossary which explains about waiting periods as well.
Should you require further information you can call our telephone service centre on 1300 362 144.
Regards

Julie-Ann--
Latrobe Health Services
info@lhs.com.au

[KiahsMum]

I am in Melbourne and went private, my health fund paid $6300 for hospital stay and that included a theatre for C/S, the anaesthesiologist (sp?) cost $1000 in total with what medicare and PHI covered we were out of pocket $280 so PHI will cover a bit more, would say at least $550 after medicare. Paed for C/S was $550, still waiting for medicare to cover their bit but PHI won't cover paed as bubs wasn't an in-patient, OB sent another bill for $1500 which will be covered by medicare and PHI so you would have to pay some of that. So I would allow at least $8000 depending on your hospital and type of birth.

[mumma2cubs]

After a bad experience with midwives in the public system, we researched PHI for this pregnancy and got pregnant before we could join (so much for my 4.5 year try with Cooper!)

We are being charged $3956 - $4111 for a 4 night stay including the delivery - lower end is for labour ward vaginally second figure is c-section in theatre. No rebate at all on that cost

Aside from that cost, we will pay a $1250 PMF at 28 weeks - of which because we are near our saftey net we'll get around 70% back from Medicare, my OB bulk bills visits, a $2555 - $3605 delivery fee and approx, $650 for anaesthesia which we'll get back about $250.

So $8561 for a vaginal delivery with epidural or $9765 for a c-section

Of that, around $875 will come back from Medicare for the PMF and $250 for the epidural.

As of January - Medicare will cull out of hospital treatments for Obstetrics, so my OB was kind enough to charge his visits in advance to "pre-pay" before the changes. In hospital rebates for me will only be the epidural...

Sucks, but that's what happens I guess.

We do have family cover now so that if bubba needs the SCN, the health fund will completely cover them as an independent patient

[RedPanda]

You'd be up for a fair bit. Thousands... even more for a c-sec. I had a friend who had a baby privately without insurance. It was ten years ago and it cost a bundle (at least $7K all those years ago - although the baby was early and hospitalised for some time which would have cost extra).
I'm not in Syd so I can't speak for those public hospitals, but I would honestly have no issue with several of the public ones around where I live. Or a birth centre.

[garfield13]

After a bad experience with midwives in the public system, we researched PHI for this pregnancy and got pregnant before we could join (so much for my 4.5 year try with Cooper!)

We are being charged $3956 - $4111 for a 4 night stay including the delivery - lower end is for labour ward vaginally second figure is c-section in theatre. No rebate at all on that cost

Aside from that cost, we will pay a $1250 PMF at 28 weeks - of which because we are near our saftey net we'll get around 70% back from Medicare, my OB bulk bills visits, a $2555 - $3605 delivery fee and approx, $650 for anaesthesia which we'll get back about $250.

So $8561 for a vaginal delivery with epidural or $9765 for a c-section

Of that, around $875 will come back from Medicare for the PMF and $250 for the epidural.

As of January - Medicare will cull out of hospital treatments for Obstetrics, so my OB was kind enough to charge his visits in advance to "pre-pay" before the changes. In hospital rebates for me will only be the epidural...

Sucks, but that's what happens I guess.

We do have family cover now so that if bubba needs the SCN, the health fund will completely cover them as an independent patient

Did you join the phi not long after you found out you were pg? if you did you could move to latrobe now and be covered if bubs not too early - as they will take into acct the date you joined the other fund and will cover you 9mths from that date? just a thought

[mumma2cubs]

Thanks for the thought Garfield13 :) unfortunately we will be induced at 38 weeks and we joined when I was about 6 weeks pregnant - so I guess even La Trobe is out.

Although it's nice to know there's a fund out there prepared to cover someone immediately if they found they were pregnant....:yelclap:

[garfield13]

bummer - you could always call and check if its only acouple of wks out. I was admitted for pains just before the 9mths waiting was up and they kindly still covered it

Good luck with bubs #2

[Lozlily]

I'm very excited cos I THINK I'M PREGNANT (had two positive takehomes...waiting for checkup with GP now)

At the same time...I am a little nervous cos we have been blessed a bit earlier than we had intended. I only upgraded my insurance to a higher cover in July this year. If i am really pregnant, it means that my due date will prob be within the waiting period (drats!)

Does anyone know what this means? I know I'm not covered...but practically - how much more will I be paying? and what are my options now?

any tips will be appreciated. I am in Sydney if that helps! thanks!


Hi there,
I was in the same boat!
Upgraded our priv health cover in June, but fell pregnant in July.
I callede HCF to see if they'd still cover us, even though baby will be born before the 12 month waiting period is up.

HCF sent me a form for my Doctor to fill out ' a notice of attendment', to advise that I wasn't already pregnant when we upgraded the cover.

And HCF assessed, and then sent a letter confirming they'll cover it.

So baby will be born in April, even though my 12 months won't be till June.

So that's lucky I guess.
Hopefully your health fund can do the same?

Having said all that...I don't think we're going to go private now anyway, just because of the huge gap fees been quoted :(. So think we're just going to go public - our local pub hosp seems nice :thumbsup:.
Good luck with it all.
:)!

[Ricebubble]

My husband and I weren't planning to get pregnant, didn't have maternity cover and were more than a lil miffed (as long time payers of private insurance) that no allowances could be made.

However as it turns out I would have ended up in a public hospital regardless - my pregnancy is high risk and the specialists seem to be in the public system. I've shared rooms with other high risk ladies that have been transferred from private hospitals because they are not equipped to deal with them.

The rooms and food might not be as nice but the medical care is the best I can get in WA - and as a public patient I'm not paying thousands for it (I've been here for 3 weeks, just imagine the dollars...)

Just thought this might reassure anyone who has missed out on the waiting period.

My Mum, who had cancer, also ended up going through the public system despite having private cover - the care offered by the public system was the best.

As a result I'm dropping my hospital cover down from the highest level and donating the difference to the state system - not only do they need the cash, they deserve it!

[Eggtastic]

Rice bubble. What a lovely thing to do!

We are also in a similar situation. Turns out we miss the waiting period by 3 weeks. Gah! Due in May 2010. I rang the PHI and the girl pretty much laughed at me. Brilliant.

After reading this thread I've emailed the Health Insurers to see if they will accept a letter from the GP and have also emailed Latrobe to see if they will cover us. (I know I should probably ring up - but a bit too knackered today to be bothered TBH)

The only thing that draws me to the Private system is having a private room and having the option of staying in hospital for a little longer than in the public system. I think statistically there are higher rates of interventions using the private system? (IE more babies are born with the help of forceps etc etc)


Argh - so much to sort out when we're still holding our breath to get through the first trimester!

[garfield13]

Eggtastic - Latrobe will cover you. They will cover you 9mths from when you have been covered for pg with your previous insurance.

We had cover from aug 07 with ahm & i fell pg was due in july 08 so missed by a month. Called latrobe and signed up and as i had had signed for in aug 07 for pg cover with ahm, thats when their 9mths started so my cover for pg kicked in may 08.

But as I found out an a couple of others, when I called ahm to cancel and told them why, they said they would ahve matched latrobe and covered me anyway. So maybe call your insurer again and say you are thinking of leaving to latrobe and see if they will match - but get it in writing if they agreed to

[Eggtastic]

Hi Garfield13.

I've just got off the phone to the PHI and they are sticking to their guns. Although for others in a similar position, (this is Medibank) they said if I had missed the 12 months by 2 weeks instead of 3 they would have covered me. Worth bearing in mind.

Latrobe looks like the way forward. Will report back...

[Eggtastic]

Thanks so much for the Latrobe tip off Garfield13. What a helpful lot they are.

:thumbsup::thumbsup: from me

[EvangelinaOne]

It depends on whether you want to go through a private ob or public hospital. If you go through the public system it won't cost you anything. If you want to see an ob privately you can choose one who works in a public hospital and this will reduce the cost of your accommodation by about half. All other costs will depend on what the ob charges and what the medicare rebate is. If you choose this option you are more than likely going to be out of pocket a few thousand dollars at least. Even people with private health cover end up being out of pocket with the Ob fees. The only things that are completely covered are the hospital costs.

[garfield13]

Glad they could cover you, i was also very happy when i found them as my closest public hospital is not really an option due to beong so busy. Will be interesting what medibank say when you call to cancel. Good luck with your pg:-)

[Eggtastic]

Well medibank asked why I wanted to leave but didn't offer to match, so I wonder if they've changed their protocol? Ah well. All worked out well in the end. :)

Thanks. fingers :fingerscrossed: crossed eh?

[tess85]

Just rang up medibank and they wouldn't waive the waiting period of 12 months....... guess I'll have to go public now.

[garfield13]

Just rang up medibank and they wouldn't waive the waiting period of 12 months....... guess I'll have to go public now.

Have you tried Latrobe? They only have 9mths waiting period

[Seema164]

I upgraded my PHI in July09, EDD is August10. I'm worried about not being covered in case of premature delivery.. Does anyone know if the health funds are kinder under these circumstances? I'm with HBA if that helps.

Thanks

[garfield13]

I upgraded my PHI in July09, EDD is August10. I'm worried about not being covered in case of premature delivery.. Does anyone know if the health funds are kinder under these circumstances? I'm with HBA if that helps.

Thanks

I cant say 100% for hba but I know my own & many others cover you going by your edd. So as long as the edd is after when you would be covered, they will cover you regardless of when bubs is born. I would call your fund just to double check - if they didnt you could change to a fund with 9mthd waiting and you would be covered from the same date you upgraded your coverage with hba - so if you changed to a 9mth waiting period fund you would be covered from march

[fifi81]

Wondering if anyone else has been in this situation. We had never had health cover before and decided on top hospital and extras and joined 20/6/2010 (teachers health fund). Got pregnant quicker than thought. If baby comes more than 18 days early we wont be covered by PHI. Is it worth the risk if I want to go private? Has anyone heard of teachers health doing the attendment letter to say we were not pregnant when we took out the cover???:)... HELP.......could be way costly.

[garfield13]

Hi,

You are covered :)

It doesn't matter if baby is early as long as your due date is after the cover has started. If there was any queries by your health insurance your ob can just supply a letter confirming your due date was 7th april.
Just call them & double check but i have this many times & people were covered. If your insurance doesnt then just change as most others do

[del79]

Wondering if anyone else has been in this situation. We had never had health cover before and decided on top hospital and extras and joined 20/6/2010 (teachers health fund). Got pregnant quicker than thought. If baby comes more than 18 days early we wont be covered by PHI. Is it worth the risk if I want to go private? Has anyone heard of teachers health doing the attendment letter to say we were not pregnant when we took out the cover???:)... HELP.......could be way costly.

Did you say 20/6 or 20/3?
If it is 20/3 then you are covered but if 20/6 then you will b short of the 12 months

[del79]

I rang up medibank and they wouldn't waive the waiting period of 12 months. Told me it's my choice if I want o downgrade to a plan without preg now. Sent me a link to their website.. Not as helpful as when I was signing up, of course.. I am lookin for some other basic hospital insurance, any to recommend? One that would cover me and my baby after birth.

[garfield13]

how far along are you??
I dont think you'll find anyone that is willing to waive the waiting period. Your coverage doesnt need to me kicked in whie your pg, just as lon as your due date is after when the waiting period has ended.
If you are close to it you can transfer to Latrobe Health as they only have a 9mth waiting period for maternity coverage & also take off any time youve had with your current insurer - eg: if your 2mths into the waiting period with your meidbank, youll be covered 7mths after you join latrobe

I changed my cover to Latrobe so I was covered for the birth of dd & they were great, ive been to hospital once since & no issue either.
We pay $139 per mth for family cover for middle of the range hospital insurance with Latrobe (with a $500exc)

[del79]

Is latrobe state specific? I am in queensland.
I am 6 weeks short of the waiting period but now, I am thinking of just going to Public and since, I don't need pregnancy coverage, just want to downgrade to something else that I dun have to pay extra for, when I dun use it.

[garfield13]

im not 100% sure but i know a friend moved interstate & it still with them, maybe jsut call & check

Well yes its best to figure out first if your going to go private or not.
For me there's not really a choice as our public hospital is so busy your out in a day or 2 & less help as they are so busy, so id only go private. But if you've got a good public hospital with a good reputation then save your self the 3-5K out of pockets & go public

[baby babay]

I have just found out that I am 6 weeks pregnant and was wondering if I joined with Latrobe Health would they cover me?

[garfield13]

Do you have any current pregnancy insurance??
You due around 3rd june? yes

If you have no current insurance & you joined today you would not be covered until 8th july, so no you wouldnt be covered.
If you've got current insurance & you've only had it for 6wks or so, you'll be covered as latrobe take that off their waiting period.
But you can always call & check if they would wave it & cover you?
When I was originally pg with dd & was looking at changing as we werent going to make our waiting period I found someone who was had no insurance & called latrobe & joined & they were happy to cover her as long as she had their top cover, so you could just call them & see