What was your out of pocket with Medibank Private?

[MamaLlama]

I just spoke to Guy Skinner's receptionist. I was kind of shocked. She told me apart from getting a private room that nothing would be claimable from Medibank Private!

And that my out of pocket would be about $2500-$3000!!!

Why the heck did we struggle to pay to keep up private health insurance so we'd be covered for pg if it doesn't help????

It would be cheaper to pay for a private room out of pocket than our yearly premium.

[Knocked_for_six]

Unfortunately your out of hospital OB expenses are not claimable on your private health cover; however once you reach the Medicare safety net, the out of pocket cost drop significantly.

With DD1 who was born last August, our OB costs were just under $2000.

We are also with Medibank Private and are able to use our package bonus to cover the hospital excess and our OB also charges a no gap delivery fee.

What were they including in the $2500-$3000 of out of pocket expenses?

[MamaLlama]

I'm not even sure what it included!
She said they bill $1500 @ 15 weeks then $3000 @ 25 weeks! And that you get some of that back on medicare.

What is the medicare limit?

[Bunnyhugs]

Medibank will cover the hospital costs. You will still need to pay an excess for the hospital, if you have an excess.

[zenifa]

When I had my two girls, we were with Medibank Private, and on a high level of cover.

The Ob appts, ultrasound scans and the Ob management fee are claimable via Medicare, not private health.
Once you reach the safety net you get 85% of the costs back. Ie my ob fees for antenatal were $50, and once I reached the safety net threshold, I got back $45.

My only cost through Medibank Private was my $200 excess, but I used my package bonus to claim some of that back.
My anaesthetist was 'no gap' so he only charged the fee that medibank private would cover.
I think I may have paid for paediatrician visits while in hospital, but that was claimable via medicare (from memory).

So what is this $2000 -3 000? Is this the management fee?

Private health covers the hospital admission and delivery of your baby (& if you are covered for the baby too, then ICU or neonatal unit stay if required) - it does not cover the antenatal part of pregnancy, only the the end.

[zenifa]

I'm not even sure what it included!
She said they bill $1500 @ 15 weeks then $3000 @ 25 weeks! And that you get some of that back on medicare.

What is the medicare limit?

Wow, I had a one off management fee for the OB paid by 20 weeks of $1200 ($1000 for the 1st bub).

So total out of pocket for us with each pregnancy was $2000 (after we claimed everything from medicare and the health fund).

[MamaLlama]

I see a neurosurgeon every year or two for a checkup (prior condition). I always got part of his fee back on medibank private, and had he been a subscriber to gapcover I would have gotten it ALL back. I don't see why seeing an OB out of hospital should be different?

Or has the system changed that much in 2 years since I last did the neuro thing?

[Knocked_for_six]

From memory the Medicare safety net is $1050, this is per calendar year - Best though to ring up Medicare and check with them.

I had to pay a pregnancy management fee at 20 weeks which was $3600 and I got back around $2300 of that. My OB appointment fees are $250 for the first then $100 up until you reach the safety net then afterwards it drops down to $15.

[Knocked_for_six]

Forgot to add, you may also have costs associated with scans, blood/pathology tests, paediatrician and anaesthetist.

[Izy]

Are you sure the fund paid for your neurosurgeon checkups as an outpatient service? And was that when you also had medicare (so a standard hospital product)?

I ask because medicare legislation (not sure if it dates back to 78 but it was definitely in place in the 90's) prevents funds from paying on medical outpatient services unless they are an ancillary service....
The idea was that they didn't want people without money being disadvantaged from those with money when it came to seeing a Dr.

[MamaLlama]

Um, I remember queuing at medicare and then medibank (when they were both in the centrepoint building in the city) after my appointments. And medibank told me they were sorry but he wasn't on gapcover so I couldn't get the rest. I don't know why but he refused to subscribe to the gapcover program.

I take your point about why there is a discrepancy. On the other hand if you pay insurance and birth is a hospital procedure and the outpatient management is just a lead-in, it would make total sense to treat it as if its part of the same hospital transaction. Otherwise wouldn't mums with no money just not go to a Dr and head to the public ward when bubs are due? Not good preventative strategy.

I used to work in the govt bureaucracy so it being illogical and stupidly counterproductive in the name of a good cause doesn't mean it isn't the way it is.

I was just surprised. Thank God my DH just got a $15K 1-year-only raise. I think its all going on the baby in one way or another at this point!

[Crazydaze]

We have Medibank cover and other than our excess ($500), we pay a management fee to the Dr at 20 weeks of $1400 (we've reached the medicare levy threashold so will get 85% back), I will pay for scans, but he has gap cover and so does the anaesthetist practice he uses so no out of pocket for the delivery and he also bulk bills all my blood tests.

We did get told that if we were with MBF (same hospy and Dr) that we would have out of pockets for delivery, extras at the hospital etc. My friend is with MBF and she saw my Dr, she also had a $500 excess and same management fee but also ended up nearly $1000 out of pocket for gap etc. So Im really glad Im with Medibank over other funds.

[Izy]

So Im really glad Im with Medibank over other funds.

All depends on the hospital and dr's preferances.... ;)

[nearly mum of number 1]

The $2500 - $3000 you are talking about is a pregnancy management fee and you receive 80% of this back through Medicare. You also pay anything above the scheduled fee for your doctor known as a gap and you also pay above the scheduled fee for any other medical professional involved in your care.

I go in to public as a private patient and get a private room and get to pick my ob who does not charge gap. A public hospital will also waive your excess on your health fund if you ask.

Public hospitals are much more advanced than private ones anyway in case of emeregency


ote=MamaLlama;3632900]I just spoke to Guy Skinner's receptionist. I was kind of shocked. She told me apart from getting a private room that nothing would be claimable from Medibank Private!

And that my out of pocket would be about $2500-$3000!!!

Why the heck did we struggle to pay to keep up private health insurance so we'd be covered for pg if it doesn't help????

It would be cheaper to pay for a private room out of pocket than our yearly premium.[/quote]