Private in Public Hospital

[mybubby]

Hi :wave:

I'm currently 9 wks pregnant with our first baby. :yelclap:

Unfortunately under my health insurance I'm not covered for Obstetrics at a Private Hospital because of my level of cover. My insurer told me however that I could be a Private patient at a Public Hosp but i'm not sure what that really means...

Because I was told that all the accomodation costs will be covered, but i'll still have to find my own obstetrician... (more costs we don't need)...

So, I'm wondering if anyone knows whether I can still be treated as private patient in a Public hospital without having to find my own private obstetrician?

Reasons being we're trying to keep our costs as low a possible as we're both still finishing off our tertiary studies.

And as you might guess I feel very ripped off paying all that insurance for the last couple of years without getting much out of it. :no: Just trying to get as much as I can out of the insurers. :yes:

Thanks in advance :)

[c38]

Being a Private patient in a Public hospital basically means that you get to choose your own Dr rather then go with whoever is on call. In some public hospitals it also pays for your tv and the hospital gets extra money if you are put in a single room but not all public hospitals have enough single rooms to give one away to someone just because they are private. So you get one if theres one free and not someone with a higher need (ie someone whos had a stillbirth or is infectious or similar)
on the otherhand a lot of public hospitals now havbith suites where you get a single room for birth and postnatal anyhow

[Littleboopsie]

when i was 22 weeks i changed my booking from private to public hospital cause i was high risk with plcenta praevia (had to).

I got my own room after 2 days when one became available and my OB continued to look after me.

You can go for all your antenatal checks under the midwife care in the hospital using medicare, and come the birth , still get a prvate room (if there is one available) as you are a paying patient.

[Brookestar]

Hi I am in a similar boat. I am 14 weeks pregnant and have not seen an ob, but will be in 3 weeks time.
My health cover is private patient in a public hospital. I have to go an see my ob in a private hospital BUT he is going to deliver mine in the public hospital.

I am freaking out becuase my husband was talking to someone at work who said it is still going to cost us about $4000 for the ob fees. I know that there would be some in pocket expenses but I didn't think it ouwld be that much!

As this is my first baby I really want to be careful and see an ob and to know who will deliver my baby, but everyone I talk to just goes and sees the midwife.

Any help would be greatly appreciated :)

[Littleboopsie]

I am freaking out becuase my husband was talking to someone at work who said it is still going to cost us about $4000 for the ob fees. I know that there would be some in pocket expenses but I didn't think it ouwld be that much!


Any help would be greatly appreciated :)


Hi Brookestar. Yes unfortunately you will have to fork out quite abit for OB checkups. We paid about $5000 for OB fees, and also about $1000 extra for all the blood tests, scans etc etc on top of that.

BUT....you can claim almost 50% back off medicare after you have had your 24th week ( i think) check up. Also register for the family medicare threshold or something (cant remember what its called but ask the OB receptionist) and make sure you keep all your receipts.

hope his helps :)

[mybubby]

Just wondering if the family medicare threshold thing is the same as "gap" cover that the insurers told me about. They mentioned something about finding an ob who does gap cover and so that will usually limit the out of pocket fees to a set amount... :confused:

I'm with medibank private and on their website there's a list of obs that are part of that...

as you all can see, i'm still pretty confused... why is insurance soooo dfficult!

[susieq1969]

I'm a private patient in a public hospital too

And basically it means that if there's a room available, as C38 says, then you'll get a single room.

At JHH my partner can also stay overnight, we get a free newspaper and parking is free too. So there are little extra perks. Also, the Excess is waived.

I am under the Group Practise Midwife's at JHH, all my tests, ie bloods and ultrasounds are free, I don't have any out of pocket expenses unless I want to get a private scan done. I'm also having bubs in the Birthing Centre at JHH.

It is true that even if you have private health cover and you want your own OB, you will still be out of pocket. My cousin went this route, and she ended up being out of pocket by $1,500.00

So it depends on what your OB fees are. And usually, Private Health does not cover the OB fees, it's Medicare as said previously. It's all a bit of rip of really, IMO, if you go that route

But, if you're low risk and have no problems, then I don't see why you can't just go the midwife route. As I said previously that's what I've done and the care I've receievd up til now is great!!

Brookestar - If you're low risk, then theres' no reason why you can't just go to a midwife. The care you receive from them is just as good. But it's up to you, it's your choice what route you wish to take.

[Littleboopsie]

Mybubby & Brookestar - insurance policies confuse me too. Im not sure if the threshold is the same as the gap, dont want to give you the wrong info. If u want to keep $$ down, just use the midwife clinic at hospy.

OB's are surgeons foremost, so really only neccesary if you need specialised care like i did. If you find out later on down the track that u need this, you can always go to one and save yourself some of the earlier costs...their fees for simple checkups are quite ridiculous... before my hi-risk probs were discovered, i felt quite ripped off.

If your pregnancy is healthy and normal then seeing the mw is all u need...all the OB does is check your weight, blood pressure and quick scan at each (short) visit and see if you have any questions. For a normal birth, usually the midwifes do most of the work anyway, the OB arrives at the end to 'catch the baby'!


Susie - i dont know anyone who was only out of pocket by only $1500 for private fees...thats pretty good! I wish i had the same.

[susieq1969]

Susie - i dont know anyone who was only out of pocket by only $1500 for private fees...thats pretty good! I wish i had the same.

Yes I was quite shocked at that as well

I don't know what insurance company she is with, I'll have to find out!

:)

[Izy]

My out of pockets will be relitavely low with this birth too.

Back to the OP. If you don't want to choose your ob then there isn't really a reason to go private in a public facility. You'd be better financially to just be a public patient in the public hospital.

The reasons to go private are primarily
* choice of Ob
* choice of hospy
* private room.

In saying that the private room will probably only be available based on your care needs rather than private/public status.

I'll try to explain a bit of the out of pockets as they usually (not always) work

Medicare will pay 85% of the medicare schedule fee rate (MSF) per visit when you are not admitted to hospital (out patient). Your fund will not pay anything towards out patient but the costs you pay (out of pocket also known as OOP) is counted by medicare as part of YOUR costs. This will help later on if you reach the safetynet.

Medicare will pay 75% of the MSF for inpatient services (when you ARE admitted to hospy). In this case your fund will also pay 25% of the MSF so that the total scheduled amount is covered.
Often you will still have an amount to pay though, because the dr's charge more than the medicare scheduled fee for various reasons (including things like insurance costs). This out of pocket figure will again count towards the medicare safety net.

Because of the way Dr's charge some funds have gap schemes where they will pay on their own private schedule so that the Dr gets more. Sometimes these are no-gap systems, other times they are known-gap systems.

The figures counted towards the medicare safety net is ONLY the out of pockets incurred by yourself.

The medicare safetynet is there to pay an aditional percentage (I think 85%?) of your Out of pocket costs (so not including other amounts already paid by medicare or your fund) for your expenses over a threshhold (seriously can't remember the threshhold).

Does that kind of make sense?

[Littleboopsie]

Izy you explained it very well!

Though Ill prob forget it all by the next time i have a baby again ...things like this (insurance, tax etc) go in one ear and out the other. Im so hopeless at these kinds of things.

[Sparrowgal]

Izy's explanation/summary was excellent! I was going to post something similar until I read what she wrote.

In response to what susieq said about low obstetric fees - just remember that obstetricians are allowed to charge ANY AMOUNT that they wish for your procedure, but your fund/medicare will only pay you a certain amount no matter what they charge (rather than a percentage back or something).

So if you think of it like... ok you're going to bake a cake from scratch, and you have to take it to the market to sell, what price are you going to charge? If you're really good at baking (or you think you're really good at baking) you can charge a huge amount and people will pay that thinking you are good (or that the cake is really good!), like $40 a cake! Or you could encourage people to come buy your cake and charge less like $4 a cake!

But some doctors don't like to charge a lot, or are not as good/popular surgeons so they charge less - it's kind of a like a business thing. So you can imagine if you had a really really busy obstetric practice, you could charge $5000 for a delivery and people will still pay it if they really want to see you. Or you might be a new obstetrician with not many patients yet so to attract more business you charge a lower fee like $1000. It doesn't mean that one is better than the other (or it might!) but it's more of what the ob really thinks he is worth.

Hope that helps with anyone who is wondering about obstetric fees.

[Izy]

Just to put another option out there with the cake example...

They may be a fantastic baker that could sell their cake at $40 but choose instead to charge about $10 and limit the number of cakes they make, cause they bake for the love of it and to make others happy. They know that $10 gives them enough profit to be happy while still making the fabulous available to the lucky.

[susieq1969]

OK, enough about cakes now!! My mouth is watering :laughing::laughing::laughing:

[Amara]

If you are going to a public hospital & don't want to choose your own OB then just go public as a public patient. That way you will see the middys throughout the pregnancy & they will deliver the baby and an OB will take over if necessary. It will cost you absolutely nothing to do it that way.

[ALHmum]

My Ob has a very good reputation and doesn't charge the earth. Thankfully :). And he is also limiting the number of patients he's seeing. Only really seeing you if he's seen you before because there's such a demand for his services.

[mybubby]

Thanks everyone! I believe I AM starting to understand it! :yes:

I'm so discouraged to finding an OB especially now that I'm almost 10 weeks along, and the ones I've rang have knocked me back (either no openings or won't go to public hosp) :no:

I still want to be a private patient in the public system regardless of having my own OB... I should still be able to do that without having an OB right?:confused:

My main thing is to get a room on my own (i know it's prioritised based on need) becoz I have loud family and don't want the hassle of trying to keep they quite and getting dirty looks from other mothers I'm sharing with IYKWIM.:D

[Izy]

In that case I'd suggest you ask the hospital for a list of all the obstetricians that deliver in the hospital you want.

That way you're at least ringing the right people.

Oh, and don't get too discouraged. Sometimes it's luck (and dare I say fate) who you can get in to see.

I started calling obs at 5 weeks pregnant (I'm due about a week before you) and it was the 5th ob I called that could take me!:eek:

Best thing is he is No-Gap, and lovely, and understands my neurosis etc :laughing:

[susieq1969]

I still want to be a private patient in the public system regardless of having my own OB... I should still be able to do that without having an OB right?:confused:



Of course you can!! I'm a private patient in a public hospital as I said before and I don't have an OB! I'm just using the midwife's.

Remember as well, a lot of OB's you see in Public Hospitals also do private work.

If you want an OB keep perservering, you'll get there!

:hugs:

[garfield13]

If your not too worried about having your own ob, then i would go as a public patient. Your going to get the exact same service, but won have to pay for an ob or excess.
Unless yo find an ob that doesnt charge alot, but mine was $3100 ($1600 out of pocket after medicare)

[Bunnyhugs]

I agree with what the other girls have said, Izy explained it really well :yes:

I'm not covered for Obstetric with my insurance either but this was a concious choice we made as we felt it was silly to pay a higher premium and then pay HEAPS of $$$$$ for OB appts JUST so that we could have our own room.

We can choose to go private in the public system so that if there's a private room available we'll get it but with DS, I was in a 2 bed room. The other girl was my age, had a boy the same day as me and it turned out that she lived just around the corner - we became great friends :D

So yeah, not really worth it in my eyes because I don't care who catches bub LOL as long as someone does and that's what the midwives do :)

[mybubby]

:yes: Thanks to all you ladies that replied :)

I've finally decided :yelclap:... I'm going as a private patient in public hospital.. and going shared care with my GP... reasons being I believe I'm low risk (young fit and healthy as far as i know, and a primip).. so no need for private OB... plus my GP's so lovely :thumbsup: i'd rather see her then a stranger..

Thanks heaps for all your help :hugs:

By the way any of you ladies from Brissie going to RBWH?

One more thing, how do you get the Pregnancy Ticker to appear on your forum replies?
It says cut and paste ... but paste where exactly?

[Brookestar]

Hi girls

Thanks for all your advice, why is it I seem to understand better when someone else explains it to me?!
I love the comparison to cake...it just makes sense!

After calming down a bit we rang the ob and the out of pocket fees will be about $1500 and our health insurance covers the delivery.
So we are all sweet, I feel so much more relaxed now I know what I'm going to do.

Just waiting now for a little kick...
Thanks all :)