Am I covered? Confused. Medibank WA

[sylvesterthecat]

Hi all,
Having had my first baby in the UK I am struggling a bit to figure out what is the deal over here! So I just called Medibank and now feel more confused than when I started and wondered if anyone could help.

Basically I am covered from 29th September 2011. However, my doc stated my due date at 27th Sept (not covered). My date of last period was 21st Dec - however I have 30 day cycles which would mean my due date is infact 29th Sept. So first question - do GPs here always base due date on a 28 day cycle?

Second question - Medibank lady said they only cover in hospital expenses not outpatient expenses, therefore I asked her if it only covered in hospital expenses and I had the baby earlier than 29th Sept - would I be covered? She said it is a case by case basis. So now my GP is asking if I'm going private or not but how can I know this if I dont know when baby is going to come?!

I hope someone can help. Let me know if I haven't been clear on anything.
Lisa

[amiee]

tbh you have probably left it a bit late to go private, most obs in perth you need to book before 6 weeks unless you are going to a gp/ob.

private health only covers you when your actually in hospital so that means everytime you would go and see your ob, have bloods and ultra sounds done you would be required to pay for this but you will get a portion back from medicare (most obs charge a few thousand). if you go public i am pretty sure every thing is free except for one ultra sound.

if its only a couple of days i would just lie about your lmp by a few days so that you are definatly covered. no one will know and babies very rarely come on their due dates anyway.

i hope that helps and good luck with the rest of your pregnancy

[sosie]

Just explain your cycle and they should change you due date for you as the scans are plus or minus a few days. I had a similar problem last year. Due on the 3rd insurance kicked in on the 1st. I would be covered for early labour but not for any admissions relating to the pregnancy that did not involve giving birth. I am also covered with medibank. In saying that, I have a 36 day cycle which they factored in to my due date. If they had not have done this I would have been in the same situation as you. Talk to your ob and he will change it.

[TinyLittleTootsies]

Hello, I will try and explain it to you! Hope it makes more sense :)

Private insurance covers you for being in the hospital.

So, even if you were fully covered (as in, have been covered for years), you would have to pay for your antenatal visits to your ob, as these fees are not covered by private health insurance, but they ARE covered by medicare for these visits, so you would only pay the gap.

When you have private health insurance, you are covered for any time you get admitted to the hospital. Depending on the level of cover, you would pay for example a one off fee of $200, or $500 and everything will be covered in a medibank "members choice" hospital.

For your case, it doesn't matter what your estimated due date is, because it matters what day you actually end up giving birth on.

If you give birth after the 12 month date, (any time after the 29th baby!) you will be covered to go into a private hospital for your birth.

If you are admitted to the hospital early for any reason during your pregnancy, and it is related to your pregnancy (as in, a pregnancy complication) you will not be covered, no matter what your due date is, so you would go to a public hospital for that.

So basically... if you are admitted to hospital for any reason relating to your pregnancy on or after the 29th, you will be covered.
If you are addmitted for any pregnancy related problems before the 29th, you will not be covered.

What I would do, is contact the obstetrician that you want to go with, and make an appointment. He would know more about working out your due date then too, for your peace of mind (but ultimatly it comes down to when you give birth). Have you had the dating scan? Or are you not getting one?

The initial visit is usually a get to know you visit anyway. I would ask all of your questions then and tell him/her the situation about everthing and see what they say. It could be an option that you get all of your pregnancy care from them (as this is not covered anyway) and then wait and see what date you give birth? If it is after the 29th, you would be set to go ahead with the private hospital this way. However I have also had friends who had all of their pregnancy care in a private office with their ob and then chose to give birth in a public hospital as a way to reduce their overall costs, or because their birth needed to be a public hospital for higher risk, this could be an option if you ended up giving birth before the 29th?

Hope this made sense! Sorry if it doesn't!

[ClassyChick]

I have just changed to Medibank health insurance and had to call them to confirm if I was covered or not as my due date is only 10 days after my 12 month no claim period.

The guy I spoke to was really helpful and went off to confirm their official policy. The main points were that you were covered for birth after the 12 month waiting period. If your baby was born before the 12 month waiting period, they would require information from your doctor/ obstetrician to confirm that the baby has in fact been born early and then they will honour the claim.

Medibank is one of the few PHI that I found that will cover you if baby comes early.

If you are really concerned and want to go private, Latrobe Health insurance only have a 9 month waiting period for obstetrics but they also dont pay as high benefits so you 'may' find yourself out of pocket for birth costs.