Going private, without cover . .??

[shymmer]

Not sure where else to post this . . .
I'm in a little bit of a dilema hoping someone can shed some light . . .

As the title says, I have no private health cover. Had my first baby (c-sec) at Mater Public (Brisbane).
I'm 18wks preg, and my GP has sent in three referrals so far to Mater Public, 1st one they ignored, 2nd one they said no - booked out, and 3rd one, asking again, have not responded yet . . going on 3weeks now.
I'm getting the feeling they aren't going to take me.
I don't want to go to Logan Public. I don't think I am in Redlands Public catchment -or I'd happily go there.

Ok, questions . . .
1. Can I use a private Ob (whom I pay for or bulk bills) but then be admitted as a public patient for the hospital stay? so I don't have those costs? Or do I have to be admitted as a private patient too and stay/pay in private rooms?
2. What Ob fees are covered by medicare - just the consults before the birth? Or is the surgery (birth) time covered too? (but not use of theatre etc)



From research I know a private Ob/c-sec will cost around $7000 more or less, so I'm wondering what we might get back.

Thank you for any info you have on this.
Plus - does anyone know the Redlands Hosp catchment area? :D

[clm1982]

Hi There,

I dont live in Brisbane but no one has replied so i thought id give you some information that i know.

1. Can I use a private Ob (whom I pay for or bulk bills) but then be admitted as a public patient for the hospital stay? so I don't have those costs? Or do I have to be admitted as a private patient too and stay/pay in private rooms?

You can have a private OB and pay for it, and go to a public hospital BUT if Mater public isnt going to take you then this isnt really worth it, i doubt they would be able to pull any strings. Usually when you book a private OB you go to a private hospital. But in your case with no cover it will cost you a packet! My hospital does allow people to pay to stay in private hospital but im not sure how much exactly. You could ring a few private hospitals in your area and say you dont have private cover and ask how much it would cost to birth there?

2. What Ob fees are covered by medicare - just the consults before the birth? Or is the surgery (birth) time covered too? (but not use of theatre etc)

Im not this far in yet but as far as i know i pay out of pocket cost for my private OB and get some back from medicare. I thought that the delivery was covered by my private health fund. I could be wrong though. Maybe you should ring a few OBs and ask them.

3. From research I know a private Ob/c-sec will cost around $7000 more or less, so I'm wondering what we might get back.

Id be ringing around and getting prices they vary quite a bit. Im in SA and am only paying about $1200 for my out of pocket OB costs $7000 sounds like a lot to me.

As far as what you would get back from medicare once you hit $1111.60 anything more than that you get 80% back, so working it out approx $4710 of $7000 you would get back.

$7000 minus $1111.60 = $5888.40
80% of $5888.40 = $4710

4. Plus - does anyone know the Redlands Hosp catchment area?

Ring them and tell them that Mater is full and is it possible to get in? Or ask them if you are in the catchment area.

Whats the problem with Logan (sorry i dont live in Brisbane) it may be your only option?

Hope this helps.

[KiahsMum]

I went private and had a c/s with DD. I think the total for the private hospital (this is in Melbourne and was covered by my private health but they sent a statement of costs covered) and the total of just the hospital stay was $5000, that was without the theatre fees and costs of the assistant surgeon, anaesthesiologist etc so you would need to confirm costs with the private hospital you wanted to go to. I agree with the above poster, unless somehow the private OB you choose is buddies with the right people at the mater they probably can't help you. Unfortunately these days it is harder to go to a public hospital of your choice due to catchment areas and overcrowding of patients. I would call the Mater and discuss with them if possible in person, if not then you may have little choice as to where to go, you could call Redlands and demand they take you and in some cases a hospital will make an exception but it will be their decision.

Out of pocket with an OB could be anywhere between $500 and $4000 depending on what you pay for the OB, then if you need a C/S you have the theatre fees and then if in a private hospy have the stay fees so I could see $7000 - $10000 easy. Some of this will be claimable from Medicare but not much, not sure about the private hospital but don't think you could claim much at all.

[Phascogale]

You can have a private OB for your antenatal visits and they will probably cost you about $20 or $30 out of pocket for each antenatal visit.

However, unless the doctor has delivery privileges at the public hospital you want to give birth in you will not have him deliver you baby.

If he does have delivery privileges you can be admitted as a private patient in a public hospital but you need to pay for it. And it will be thousands of dollars.

You can also have a GP do your antenatal visits if you have one that's got an OB endorsement thingy.

Theoretically, if you are in labour, you can front up to a public hospital and they have to take you regardless of whether you have booked in or not. But you need to be fairly along in your labour and birth is not far away.

[ladybugblue84]

Sorry I don't know anything about the paying for private without cover thing (I was wondering how much it would cost too so thought I'd drop in & see) but I think you can put your case forward to be considered for the Redlands hospital even if you are not in the district. My sister lives in Kooralbyn (out past Beadesert) & she got accepted but went to Logan anyway. My friend lives at Jimboomba & got accepted to Redlands & went there. To me it seems they are quite open to accepting people outside of their catchment.

P.S. I went to Logan & thought it was ok.

[mumma2cubs]

I hope I'm not too late with this.

I am doing exactly what you're doing.

I don't have private health insurance and only 3 out of about 12 Dr's would have me.

The hospital choice I only had was private, but had it explained to me that if my Dr delivered in the public hospital, I could have delivered in a public hospital as a private patient and I would have paid for everything. Medicare won't touch a cent.

My first delivery I paid for an OB until the last minute, then switched to public with midwives. I will NEVER do this again after a horrific experience.

Although it'll cost around $12.5k, we are prepared to pay this.

So, the breakdown of the costs are:

- 5 day stay in private hospital, labour ward included = $5903

- If caesarean happens, add another $1000

- Blood tests etc completely out of pocket approx = $600

- Special Care nursery = $879 per night

- Epidural depends on person administering on the day, but approx = $900

- OB Preg Management fee = $1980

- Delivery fee uncomplicated = $2555

- Delivery fee complicated = $3600

This also doesn't cover regular appointments with OB - which are $80 after the first, which is $140

[mtilly]

Wow! That is crazy. I will stop complaining about my private health premiums!! I used to work in a maternity unit and some of the bubs who were prem or unwell spent a few weeks in the special care nursery (small public hospital, not NICU). A 10 night stay in the nursery for bub would blow your budget... $8790!!

[shymmer]

Thank you so much for your replies. I appreciate all the information.

I took your advice and phoned Redlands Public and they took my referral! They do not have a zoned catchment area and take everyone - at the moment (but they are currently in the process of zoning a catchment). I was told if the zoning came into play before my due date then I may be transferred to Ipswich. Only about 7weeks to go, so hopefully that won't happen!

It didn't actually occur to me that a private Ob probably wouldn't be able to get me into the public ward at the Mater anyway, since they are 'full' - so thanks for that realistic insight!