View Full Version : PHI waiting period - high risk pregnancy with twins
Hi everyone,
So, the story is that our 12 month waiting period is up on October 14th, with babies (twins) due on November 6th. Not a problem....or so I thought. Turns out our twins are mono-amniotic, mono-chorionic (one placenta, one amniotic sac) - meaning it is a very high risk pregnancy. Most women in this case will be admitted before the birth to have daily monitoring - anywhere from 26 weeks I believe. Now I am in a massive panic about the PHI as we definately will not be covered this early. Although we will probably have the twins in a public hospital (better care if they a premmie), if I have to be admitted this early on I would prefer to go private until I need the C-section.
I have been with MBF all my life, under my parents cover and then I took over on my own at about 25 (now 28), and my husband has just left HCF to join my fund last year.
Does anyone have any experience in a situation similar to this? I want to ring them and ask if they will cover me, being that I have been with them for so long. Does threatening to cancel your policy ever work?
Any advice would be greatly appreciated as we are quite distressed about both the news of the high risk pregnancy and various other financial factors.
Thank you all :)
Knocked_for_six
13-04-2009, 11:09
Firstly congratulations on twins. :yelclap:
I remember reading somewhere that if your baby/ies are born before their due (which you would have been covered for) you are still entitled to cover, although may be best to contact you PHI.
Thank you :)
No, it is actually printed in their product disclosure statement that this is not the case.
Wouldn't you think though that in a rare situation like this they would rather assist than lose a loyal customer? Well, thats how I see it anyway, but I know insurance companies can be heartless.
Knocked_for_six
13-04-2009, 11:21
Sorry to be the bearer of bad new but just had a look at MBF website for you and they state that ‘12 month waiting period prior to birth applies, even if premature.’ :thumbsdown:
However Medibank private says that ‘...benefits are payable during this waiting period for premature births and complications arising from the pregnancy where a medical practitioner confirms that the baby was not expected to be born until after the waiting period’
So may be best to give them a call and see what they can do, good luck with it all :hugs:
I am not sure about yours but my private hossy said that even with cover, if there are any complications prior to 36 weeks I would have to go to a public hossy anyway duie to the level of care those babies would need.
Do you have an Ob? because even if you need to get a c-section the Ob would still do it in a public hossy and you could then transfer to a private - obviously if you waiting period is up.
As knocked above said - you may be able to transfer to Medibank Private - I am sure I read somewhere if you have served anyw aiting period with another provider that is counted on the new cover.
I have looked at MP webiste, will give them a call tomorrow. I am wondering though if this will be classified as a pre-existing condition and if so they may still not cover me either.
Why does all of this have to be so hard??
TripleTime
13-04-2009, 12:52
I am with Commomwealth Bank Health Society & my girls are mono-chorionic, meaning they share a placenta & sack but have a membrane between them so no skin to skin contact like Mo-Mo twins.
I am not covered & nor are our girls untill next year.
Honeslty you'd be better off going public in a public hospital as you will have the same level care & NICU is $6000 per day if you are private.
Knocked_for_six
13-04-2009, 13:07
I also forgot to add that baby-2 will be admitted to hospital as a patient as will baby-1 once you are discharged and I *think* that they will only then be covered under you health insurance if you have family cover, sorry I can't be more certain as we had family cover prior to having our first child
TripleTime
13-04-2009, 13:13
Im pretty sure thats the way it works too,
Ive set our up so that my Mum is a contact & can add our 3 as soon as they are born & our cover will go from Top Couple to Top Family.
I know i have a month to change it but i want it done ASAP
The Dr. that I am seeing tomorrow delivers in both the public and the private (right next to one another). I am preparing myself for delivering in the public hospital, but if I need to be an inpatient for weeks before their birth (to be monitored) then I would prefer to be in private. At the end of the day I will do what is best for my babies, but I know what public hospitals can be like and I dont want to go crazy in one while waiting for my babies to arrive safely.
As for the twins being admitted separately - you mean just in private hospital, right? There wont be an issue in public will there? They will definately be in public as the private hospital do not have neonatal intensive care, only the public do.
bumblytumbly
13-04-2009, 15:03
Congratulations of your twins firstly :smiliedance:
Secondly I think MBF may be one of those providers that are a real pain in the bum. Friends of ours had twins early and they would only cover the first twin :rolleyes:
I would definately ring them and see what your options are.
We are with Medibank Private and they do "waive" the waiting period if you go early but you have to have a signed stat dec from your OB stating that you were due after the waiting period expired.
Maybe you could do this ??
Yeah, I am going to see if they can do that. But still worried they may not take me as it is pre-existing. It wouldnt really be in their best interests would it??
Arrrrgh, I am driving myself mad with all this. As if there isnt already enough to worry about.
Basically, I dont care now where the hell I go. I just want to make sure I have MY doctor. I dont want some random who has no clue about my situation!
Does anyone know much about being a public patient in a public hospital and having your own OBGYN?
Sheer Bliss
13-04-2009, 15:52
:hugs: I don't think they can count it as a pre-existing condition, as when you signed up for cover, you wouldn't have been pregnant, it occured AFTER you joined, and even your EDD is after the waiting period. If they say it was a pre-existing condition they are a55holes and you should go to the media for them being misleading.
If you end up delivering early - the BEST place to be IMO is in the public system. IT is much better equiped to deal with premmies and you will have access to the best NICU's, even if it is via a hospy transfer.
My private OB wll deliver at the privat hospital after 34weeks, if my twins come before that, i'll be off to the big public half hour from my place - and i'll be happy that they babies will be receiving the best care possible.
Yes, I am definately going to have them public, but concern is that I have my own OBGYN. Because this is such a high risk pregnancy (mo/mo twins) I dont want to have just anyone deliver them without knowing my and the babies history. I dont think that is too much to ask for in this case!
I know they will get the best care in public as they will need intensive care, but I also dont want to be taken care of by midwives etc.
Is your twin pregnancy fairly straightforward? Will you be in public as a private or public patient?
HappyLittleChappy
13-04-2009, 16:09
As an ex employee of Medibank Private I can give you a little info.
The information about MBF not covering premature babies is in fact correct. They do not. It's a sad fact, but MBF are quite strict and have so many unfair rules it's not funny.
Medibank Private however WILL cover premature babies as long as you have your OB sign an "EDC Form" (which you can get from any Medibank Private centre or via mail). This form states the date the babies are DUE, and as long as that date is more than 12 months after joining your private health cover the birth will be covered no problem.
As for switching between MBF and Medibank Private. - Medibank Private will NOT class the pregnancy as pre-existing. They cannot. They simply honour the previous months you have served in your waiting periods with MBF. If you've been with MBF (with pregnancy/obstetrics cover) for 3 months then Medibank simply makes you wait the further 9 months until you are covered. EXCEPT in the case of premature birth, this will be covered as I stated above.
There is another silly rule with MBF, that you must be in and pay for 12 months of FAMILY cover before your child/ren are born. No other private health insurer that I am aware of have this silly rule. You can be on a SINGLE person or COUPLE cover right up until the day you give birth, then you switch to a family no problems.
If you've got more questions give Medibank Private a call, or you can PM me if you like and I will try to help.
Congratulations on your twins :)
peainapod
13-04-2009, 16:20
I am with MBF on top level single cover and they told me I must switch to single parent or couple cover 2 (or was it 3? - baby brain!) months before the birth - even if it comes prem. (so better to switch earlier if risk of prem).
If I had already been on couple cover the baby would have been already covered due to my level of cover.
I have already served all other waiting periods as I am a long serving member.
So some of the information others have given you is incorrect/misleading.
It is best to call them and confirm what your level of cover entitles you to.
I am going to call them tomorrow and upgrade to single parent cover just in case the baby comes early. It will only cost me $10 per fortnight more to have the baby covered.
Cheers!
Sheer Bliss
13-04-2009, 16:37
Yes, I am definately going to have them public, but concern is that I have my own OBGYN. Because this is such a high risk pregnancy (mo/mo twins) I dont want to have just anyone deliver them without knowing my and the babies history. I dont think that is too much to ask for in this case!
I know they will get the best care in public as they will need intensive care, but I also dont want to be taken care of by midwives etc.
Is your twin pregnancy fairly straightforward? Will you be in public as a private or public patient?
I'd ask your OB about it too. Some OB's deliver as a public OB in the public hospy's too - depends on your area though. My OB doesn't deliver at the public hospy though. And if you ARE in a bigger hospital (capital city) you are much more likely to have a more specialist OB. We have a great public hospy here, and if you are having twins, you automatically are under the care of certain OB's, and they do the scans etc. I would think it would be more so with mo-mo twins. I have di-di twins (boy and a girl) so it's much lower risk. I have a history of PE with my previous 2 pregnancies, but it's all looking good so far, and so long as I make it to 34weeks, i'll be in the private hospital with my OB. If i go earlier than that - i'll probably be a private patient - as there is a brilliant OB that will deliver breech babies (ATM they keep swapping about) and i would definately like to have him as my OB. If t wasn't for OB choice, it woudn't bother me, as they are more likely to give you a private room with twins anyway - if possible.
Knocked_for_six
13-04-2009, 17:12
If you don't mind me asking what city are you in? As with Mater Mothers' Private & Public in Brisbane they both have access to fantastic first-rate NICU and with a high risk pregnancy in public you will be assigned a specialist OB, you will be in good hands either way. I would choose the Mater Public without hesitation over a smaller suburban private hospital.
Happy Little Chappy - thank you so so much for that information. I will def. call MP first thing in the morning. I really hope they can be of help to us. I am out of my tree today about everything, as you can probably tell! I will let you know how I get on with them!
PP - I am in Sydney. The hospital I am looking at is Westmead, one of the largest public hospitals in Sydney. I def. will be going there over a smaller public hospital.
Ok, hopefully I can clarify a few things. For starters the 12mth wait is actually federal. The funds do have the authority to give a little leway and so do MBF.
For some clarification on your early hospital visits... when you are admitted for any kind of check the patient is YOU not the baby, so as long as you have been on a pregnancy supportive cover (even partly as a dependant) continuoulsy for 12 months (could have had up to 2 months break between family and own single) than YOU are covered, but your babies will not be untill they have served thier waiting periods.
We are with Medibank Private and they do "waive" the waiting period if you go early but you have to have a signed stat dec from your OB stating that you were due after the waiting period expired.
MBF can do the same thing... they can give you a timeframe, but chances are with Monochoro, Mono Amnio twins it'll be well before any 'consideration' time granted by any of the funds.
The information about MBF not covering premature babies is in fact correct. They do not. It's a sad fact, but MBF are quite strict and have so many unfair rules it's not funny.
uuummm... no. You worked for medibank not for MBF. You can make comment about the inner workings of the funds you know the inner workings of, I do not spout information about MBKPVT as I haven't been trained by them, likewise you do not know the inner workings of MBF
As for switching between MBF and Medibank Private. - Medibank Private will NOT class the pregnancy as pre-existing. They cannot. They simply honour the previous months you have served in your waiting periods with MBF. If you've been with MBF (with pregnancy/obstetrics cover) for 3 months then Medibank simply makes you wait the further 9 months until you are covered. EXCEPT in the case of premature birth, this will be covered as I stated above. All funds that subscibe the PHI code of practice also do this. MBF included. MBF does cover premmy bubs, as long as bubs has served thier waiting periods. I have been on a couple cover with my DH for over 12months so any baby we are lucky enough to have has already served it's waiting periods automatically. We don't need to change our cover at all as I am paying to be covered for more than one person and our cover CAN support a child without changing product, only changing scale.
There is another silly rule with MBF, that you must be in and pay for 12 months of FAMILY cover before your child/ren are born. No other private health insurer that I am aware of have this silly rule.
Do you know how many funds there are out there? Have you looked at their product information? It's actually fairly standard that a single cover covers a single person only....
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Oh, and they will not consider your twins pre-existing, or pregnancy pre-existing. It has it's own category with 12mths wait for pregnancy and birth. This has nothing to do with pre-existing at all. Even in the sad case of miscarriage MBF will cover you once you have served 2 months as it's no longer classed as pregnancy and birth and it's considered a 'sudden and accute condition'.
twinmummee
14-04-2009, 14:56
Ok, so I am going to stick up for MBF here, as that is who I have always been covered with I can't comment on any other fund and won't. Here is our experience with MBF.
I have had singles cover for years at a high level that covered me for pretty much everything. On May 8 2007 I switched to Couples cover as we were planning on TTC starting at the end of June 07 ( I left it very late to change). In September we found out we were pg with a EDD of May 27, then in October we were told it was twins and could be due up to 3 weeks earlier. Given the nearness of this date to my cover change 12 months I was very concerned. I rang MBF and explained our situation and was told that worst case scenario due to my pre-existing single cover I would be ok but we would need to pay excess for both bubs if they came early. Once we moved to QLD I went and saw my local MBF office and can't speak highly enough of the ladies there who took me through everything step by step. EVery question I had they answered and I was never given incorrect or misleading info.
I never had to change from couples to family until after the girls were born and from memory was told you couldn't change until the girls arrived as we were still only a couple at that stage - which made sense to me.
As it turned out our girls were born by c/s on May 9 and the only cost to us was my excess (for me only) and the ctg's I had in the weeks prior to their delivery.
I think you will find "horror" stories out there for most funds... and afterall they do recommend changing to a higher level of cover well before you start TTC just in case - we took a risk changing when we did, and like I said we got really lucky!
(our girls weren't mo-mo, but I did have complications with my liver also in the end which could have led to them needing to be delivered earlier than they were)
Just to update you all, MBF actually WILL NOT cover you if your babies are premmie and do not meet the 12 month waiting period due to this (which is the issue at hand, not whether or not they cover premmie babies as suggestion has been made).
I know this for a fact as I have spent half of today dealing with them and although I have been a member with them all of my life, they are not at all leanient in this matter. I have cancelled my policy with them for this reason.
HCF and Medibank Private, however, will cover me provided I have an EDC form filled by my GP and Obstetrician stating that my due date falls after the 12 month waiting period, which it clearly does.
Hopefully this helps anyone else in this situation in the future as it can be quite distressing on top of already distressing news.
HappyLittleChappy
15-04-2009, 08:36
My apologies Izy, I did not mean to offend you.
Before posting my response I actually called my ex-manager at Medibank Private and she gave me the direct number to the manager of the local MBF retail centre here for me to speak to.
So any information I posted about MBF actually came from the manager of the local retail centre, my apologies if any of it is incorrect I was simply passing on what I was told. I did not ask for in depth answers so there may be more to the situations than I have posted.
As for the single cover only covering a single person. Medibank Private adds the newborn bubs to the cover from the day they are born which makes them covered. This applies in a premature birth or at term. So if the OP was to give birth at 6 months, both bubs would be added to the cover from that day which means they are then covered even though they're premmie. There is no waiting period for babies who's parents have served all of their waiting periods.
Hello
Can anyone give me some advice? My wife is now nine weeks pregnant with twins, she has been insured with MBF Standard Hospital cover for nine months and the babies are not due until late October.
Having visited MBF this morning, I was informed that she is only covered for the single child and they seem to offer no option to upgrade our cover to include the second baby.
Obviously this is a bit of a worry, the hospital that we are booked into charges $700 a day for the second twin!
Has anyone else had a similar experience? I doubt that any other insurance company would let us join them at this stage.
thanks
Yes you can upgrade to family cover (add yourself to the policy). If you do it as soon as possible your wife and both the babies will be covered for sudden and accute conditions after 2months of the change. Congenital conditions will not be covered (things like hole in the heart and downs syndrome) untill you have been on soleparent or family scale for 12 months.
remember that standard cover will cover pregnancy and birth and things for the kids, but will not cover Joint replacements, and renal dialisis for chronic renal failure as per it's exclusions. You can Upgrade at the same time if you wish and renal dialisis will be covered after 2 months if it is not congenital (normally is developmental and considered 2mth wait).
Please be ready to pay 2x the excess. Once for your wife and once for the second baby (the first baby is considered a 'visitor' in the hosp and is not admitted so doesn't pay excess).
Talk to MBF on 131 137 for anything more or so that they can confirm this info against your cover.
Yes you can upgrade to family cover (add yourself to the policy). If you do it as soon as possible your wife and both the babies will be covered for sudden and accute conditions after 2months of the change. Congenital conditions will not be covered (things like hole in the heart and downs syndrome) untill you have been on soleparent or family scale for 12 months.
remember that standard cover will cover pregnancy and birth and things for the kids, but will not cover Joint replacements, and renal dialisis for chronic renal failure as per it's exclusions. You can Upgrade at the same time if you wish and renal dialisis will be covered after 2 months if it is not congenital (normally is developmental and considered 2mth wait).
Please be ready to pay 2x the excess. Once for your wife and once for the second baby (the first baby is considered a 'visitor' in the hosp and is not admitted so doesn't pay excess).
Talk to MBF on 131 137 for anything more or so that they can confirm this info against your cover.
Hi, Thanks for the advice. The MBF rep that I spoke to told me that there would be a 12 month waiting period if we wanted to upgrade to family cover and in his opinion it would not be worthwhile. I will give them a call to discuss, if paying a more in premiums and double the excess is all that is required to ensure that the three of them are covered then that seems fair and reasonable.
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