Claiming from Private health fund and Medicare

[beebs]

Ok - so I am totally confused about all this. I heard yesterday that neither one touches your Oby Gyn's management fee. Is that correct? So exactly what can you claim in regards to an oby gyn and pregnancy?

[RockmelonDreams]

Hi, my health insurance fund pays a portion of the total bill for the OB GYN. The % amount depends on whether or not a medicare rebate applies and whether or not the dr chosen is on their approved list of dr's who they have an agreement with. I'd ring your health fund to find out for sure what they cover. With ours if we pick a dr who doesn't get a medicare rebate and isn't on the agreed dr list then we get almost nothing back from our health fund whereas if we pick an agreed dr and they get a rebate then the costs are covered 100%.

[KiahsMum]

My OB charges a fee at 15 weeks which is not claimable from anyone and a second fee at 30 weeks which is claimable from Medicare. I only have hospital cover so can only be covered for the in-hospital fees from OB.

[HeidiLee]

Our 20 week management fee was claimable from medicare (what amount you get back depends on where you are in regards to the safety net).

Our OB's delivery fee is fully covered by our private health as our OB and MBF have an agreement to that effect. However if your OB and your private health dont have that agreement you may have a gap fee that you have to pay.

Your private health provider will be able to tell you.

[HappyLittleChappy]

You should receive a small portion of your management fee back from Medicare however as far as I know there is only one private health insurer that will give a portion of the management fee also. (call to ask if this is your insurer)

Any blood tests you have whilst pregnant will have benefits paid via Medicare, and also any OB appointments which are charged separately from the management fee.

Your private health insurer only pays for in-hospital charges which would hopefully only be the actual birth of your babies.

[Sheer Bliss]

You should receive a small portion of your management fee back from Medicare however as far as I know there is only one private health insurer that will give a portion of the management fee also. (call to ask if this is your insurer)

Any blood tests you have whilst pregnant will have benefits paid via Medicare, and also any OB appointments which are charged separately from the management fee.

Your private health insurer only pays for in-hospital charges which would hopefully only be the actual birth of your babies.

:iagree:

with both my previous pregnancies, Medicare had given us a small protion of the management fee back. But the big $$ that it is means that we hit the 80% out of pocket threshold and got almost all of it back with DS!

Every appt i had with the OB, i took the paid bill to medicare and got the std rebate amount back, same with blood tests.

I got a few bills for blood tests and tablets while in hopsy before i had DS, and these wre claimable in full from PHI, and medicare.

[Izy]

The way it typically works....

Private Health Insurance Funds (PHI) only pay for the 'inpatient' portion, so only the bits you are admitted to hospital for, and they pay for services in accordance to the medicare schedule.

For this reason they only pay benefits on items that can be billed to medicare while you are in hospital.

All lead up appointments are medicare only, and any service that does not have an item no is USUALLY unclaimable.

Good news is that many funds recognise that the medicare scheduled fee for some item no's are way too low, so they have all sorts of 'gap programs' to reduce your out of pockets.

These gap programs still work with the medicare billed items though. 'Management fees' as the term is usually used, is a charge above and beyond the item number for the actual service and so is not claimable from medicare or your PHI. (but the term is sometimes also used to describe the full advanced charge which is partly scheduled, partly not)

Do keep a good record of all your out of pockets though cause you may reach the safety net, and/or be able to claim medical expenses in your tax return. :thumbsup:

Good Luck