Are all private medical funds equal???

[littlepickle]

I was wondering if anyone can give some advice on Health funds
I am currently with Medibank Private, and have the smartplus membership which apparently covers me for obs/gyn and will also cover the baby too when we have one.
I am pretty new to the phone private medical fund thing and dont really know what I am covered for and what I will be out of pocket for if I choose to go to a private hospital. I was wondering if some health funds have better benefits than others. Has anyone done a comparison or are they all much of a muchness?

Thanks
x :confused:

[rynosmum]

I thought that they were all pretty much the same but you say that OBGyn is included in yours so maybe not.

I am with NIB and had to pay about $200 out of pocket for the labour but had to pay ALL of the OBGyn and only claim a portion back from Medicare.

If your fund covers all of this, that is fantastic !

[rynosmum]

Sorry, I don't think I really answered your question.

Private healthcare covers your in-hospital stay including delivery, prescribed medications, meals, midwife and physio visits etc

If you need extra intervention and the specialist charges more than the 'agreed' rate however, you may be charged the portion of his/her rate above the agreed rate.

[littlepickle]

I think that the catch with mine is that I would have to chose an odgyn from their preferred list if I wanted it to be coered, otherwise I would need to pay the gap payment - I think thats how it works. I have tried reading through the leaflets and brochure and I find it all very confusing...

I have read horror stories of people having their babies in a private hospital and being presented with a bill for 5000 EEEK! I hope this isnt right, I already pay 170 per month already and have done for the last 12 months whilst never actually having to use the private health fund. I wouldnt want to et a huge bill on top of that! scary ..

[zenifa]

Littlepickle
Like you I also was confused as to what things are covered and what isn't.
I have advantage plus level of cover, so it may be different to you, so it may be worth calling them to check, the ph no is on the back of your membership card.

The cost of OB/Gyn appts & ultrasound scans were not covered but you can claim some of that back through Medicare. Amount depends on whether you've reached the threshold for eg I got half back for my u/s scan and 90% back from my ob/gynae appts.
It also doesn't cover antenatal classes, appts with private lactaction consultant or folllow up mother and baby clinic appts once bub is born. I had to pay a $200 excess, which I claimed back through my package bonus.

So what did it cover - my hospital stay and it paid for the anaesthetist, obs/gynae and paediatrician during that hosp stay, I only paid the $200 excess, nothing else!! When I was discharged from hospital there was another lady who was not in a private health fund who paid upfront for her stay - it was $720 per night, $2000 for the delivery of her baby, plus she had to pay a deposit of $1000 prior to the birth to be booked in, so it did cost her heaps!!

Hope that is of some help. Z:)

[jlrjyeboah]

I too have medibank private (smartplus with hospital) and it covered everything, from ob/gyn to hospital stay. I only had to pay my $200 excess when I left the hospital. With my first ob appointment I was asked which health fund I was with and then didn't have to anything else to do from there. But I would call, just to be safe. :)

[nickosmoo]

Hi

I've been looking into this for what seems like years!! And still haven't got cover - maybe I'm looking into it too much - anyway I found out that some obgyn's still charge you a gap if your private medical insurance doesn't cover it and this gap amount can vary from ob to ob so check with the ob and the insurers just to be sure.

[Chickadee]

I had Medibank Private Visitors Cover when I was pregnant. When we signed up it covered 100% of ob/gyn visits, all specialists (paed, anasthesia etc) - no gap, no excess. 6 weeks before I was due they changed the cover level to only 80% and bumped the cost up by nearly 50%. From around $3500 a year (2 adults) to over $5000. Can you guess I wasn't happy!!

It pays to shop around.

[bananasmum]

I think that the catch with mine is that I would have to chose an odgyn from their preferred list if I wanted it to be coered, otherwise I would need to pay the gap payment - I think thats how it works. I have tried reading through the leaflets and brochure and I find it all very confusing...

I have read horror stories of people having their babies in a private hospital and being presented with a bill for 5000 EEEK! I hope this isnt right, I already pay 170 per month already and have done for the last 12 months whilst never actually having to use the private health fund. I wouldnt want to et a huge bill on top of that! scary ..

littlepickle I used to work for medibank. On smart plus 9as with any of their other covers, you will have an excess to pay $200 for you and $200 if baby has to go into special care.
Medibank only cover you for inpatient services (when you are admitted to hospital) scans visits before hand are through medicare.
You ahould ask you Ob if you will have an out of pocket for their fees (medicare and medibank pay up to what is called the sehedualed benefit but most Dr's/specialists charge above this and this is wherew the horror stories come from). Your ob should tell you if you will have out of pocket if you go private. Medibank do not have members choice Dr's they only have a list fo those who have previosly agreeded to charge no out of pocket or no more than $800 for the surgery.
Hope this helps

BM

[JanetF]

Just because you have private insurance doesn't mean you have to use it. The last thing I'd use it for would be birth as the outcomes in private hospitals are very poor compared even with our sad public hospitals. If you put your money towards a private midwife, and many funds cover all or part of this, you and your baby will have a much safer, more empowering pregnancy and birth. If you hire an Ob, you'll be hiring a surgeon who specialises in complicated birth, not the ideal carer for normal pregnancy and birth,. It's like going to an Ear, Nose and Throat specialist when you have a cold, just not necessary. I hope you have a beautiful pregnancy and birth :D

This is the gold standard guide to maternity care from WHO.
“Care in Normal Birth; a practical guide”
http://www.who.int/reproductive-health/publications/MSM_96_24/care_in_normal_birth_practical_guide.pdf


Try this too:
Midwifery Matters, Winter, 2000, Marie O'Connor
The benefits of midwifery care
There is ever mounting evidence showing that primary care provided by midwives is as safe, or safer, than care provided by doctors. A recent American study of four million low-risk births (MacDorman and Singh, 1998) showed that the outcomes of midwife-led births were significantly better than those of medically supervised deliveries. The risk of having a neonatal death was 33% lower with a certified nurse midwife than with a doctor, while the risk of infant death was 19% lower in midwifery births than it was in physician deliveries.
Midwifery has also been shown to have salient advantages in the area of preventive health. Modern obstetrics has failed to reduce the number of low birthweight babies being born. In Britain, where the percentage of low birthweight babies is higher than it is in Albania or Latvia (Cumberlege, 2000), Ann Oakley has demonstrated that the provision of social support by midwives has a markedly beneficial effect on the physical and emotional health of high- risk mothers and on their babies' well-being: these effects are still measurable one year after birth (Oakley, 1992, pp 277-79). In the United States, MacDorman and Singh (1998) showed that the risk of having a low birthweight baby was 31% less with a certified nurse-midwife than with a doctor. Small babies are associated with significantly increased perinatal mortality rates.
Recognising (ten Hoope-Bender, 1997) that midwifery care can result in shorter labour, less medication, and fewer interventions such as surgical or operative deliveries, WHO (1996) has concluded that midwives are the most appropriate, and cost-effective caregivers in normal pregnancy and birth.

[mummycloud]

Janet I agree. The only reason I had my 4th child at a private hospital was because the place I went to has an emergancy department and special care nursey. It's way too risky to have a baby in a private hospital without those things in my opinion.


I'm with HCF and I have top plus cover $100x8, which means I am covered for everything in the hospital like delivery, specialists, medications, meals etc and specialist care for the baby if need be. The only problem is that the 100x8 means that the excess is $100 a night for 8 nights per person (not including the newborn). But I'm only paying $35 a week for a family of 6 for the cover.
I also had to pay $65 per antenatal visit (medicare refunded around $20 out of that, each visit) and an out of pocket fee of $810 but by the time I was billed that, I had reached my saftey net from all the antenatal visits, ultrasounds and blood tests, so medicare refunded %80 of the our of pocket fee and also once the saftey net was reached Medicare refunded $52 out of the $65 for the last 6 visits. I think I had to be out of pocket $800 to reach the safety net. All up I was out of pocket around $1500 over the 40 weeks.

If I have another baby I would preffer to pay for my own doula and have the baby at a public birth centre under midwife care. It will end up costing less, and I would probably have a better birth :)

[littlepickle]

Thanks everyone for your advice, Its been a great help, I guess it will just be the $200 excess and the out of pocket expenses for the obs and scans, but I can liv with that, I was just concerned that i ould be presented with a huge bill before leaving hosp!!

Janet - I agree with you, on having a more natural birth, my reasons for being private are more to do with my own health, I have a little heart condition that is monitored. When looking for an obs, I did my research to make sure that the obs would be sympathetic to active birth and drug free etc as that is how I hope things will go. I am also going to hae a doula to help me towards his goal, It would be a wonderfull experience to be able to go drug free etc - heres hoping!!

[shanz]

Hey there just a little bit of maybe useful info. Not sure how other private hospitals operate but we had our booking in app two weeks ago and they got all our info and the fund name etc and they contact the health fund to check out the cover. 1 week later we got a detailed quote of how much it will cost plus a list of any of the extras we can purchase or may need to pay for. This is very helpful as you are not "flying blind" so to speak.

[andre]

Getting a straight answer from any of the funds you talk to regarding private insurance is pretty difficult – “it depends on this” or “depends on that” :mad: ! Private health insurers make it as difficult as possible for fund members to access any information which might result in their having to pay - in my experience.

EG.

While in hospital Joanne (my lovely wife :D ) completed forms to have our son Matthew (8 weeks) included in our insurance. Only to be informed 7 weeks later by the hospital that Medibank private had no record of such an application and would therefore not pay for Matty’s hospital fees!

Things worked out ok once Joey spoke to someone from Medibank and we received a letter and a new membership card this week, telling us that Matthew is now covered - congratulating us on being part of blah, blah and that Medibank will continue to blah, blah, blah, blah! The letter does not tell us, however, what our private health insurance premium now is per month! Luckily however it did have a helpful pamphlet on privacy and a thick booklet full of other impenetrable facts and figures. :rolleyes:

Joey rang again to ask for something in writing stating the premium per month and was informed her request would be forwarded to the ‘special correspondence unit’ for processing!

Feeling like a cog in some vast bureaucratic machine sucks!

Good luck. :rolleyes:

Andre.