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  1. #1
    leajones22's Avatar
    leajones22 is offline Just when the caterpillar thought the world was over, it became a butterfly
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    Default Medicare rebate for OBs

    I have noticed that people on hear have been saying that this year the changes to medicare mean that rebates to obstetric services will be capped at $300. But that is not true the following quote has been taken from the website listed :
    http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/News-medicare-rebates-for-obstetric-services

    "Over a standard course of maternity care, the base MBS rebates have been increased by about $300 per patient. This means patients will now receive a higher rebate before they qualify for the Extended Medicare Safety Net (EMSN)."

    As it says rebates have been increased by $300 which means you will get more back not less. I hope this helps.

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    I'm not 100% sure - but I thought it was a significant change to those who go private?

    From the same website quoted by OP:

    "Item 16590 has also been amended in the obstetric section of the MBS.
    16590 Planning and management of a pregnancy that has progressed beyond 20 weeks provided the fee does not include any amount for the management of the labour and delivery, payable once only for any pregnancy that has progressed beyond 20 weeks where the practitioner intends to undertake the delivery for a privately admitted patient, not being a service to which item 16591 applies.
    Schedule fee: $306.30 EMSN Cap: $203.00

    The above item has been amended to clarify that this planning and management service should be used where the medical practitioner is intending to undertake the delivery for a privately admitted patient."

    It means that the 'big' management fee cahrged by private OBs does not count much towards your safety net (meaning you are more out of pocket) as that was the major fee that took you over your safety net - therefore you got a significant amount of it back from medicare.

    Is that correct?

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    I went into medicare and spoke to a lady behind the counter the other day and I cant remember the exact figure she said but I think it was like the below.

    Once you hit the medicare safety net you if you pay $100 for your OB visit you will get $60 something back. (I think it was $62)

    Last year year when I went it was roughly $80, so its a bit of a difference.

    Also last year when we paid our planning and maintenance fee of $1575 we got almost $500 back she said this year when we paid it would be capped at $300.

    I cant remember what she said about the u/s.

    So if you add it all up it works to be quite a bit more expensive, thats why this time round I think we will see a GP/OB as it will be heaps more cheaper.

    Any way I hope this helps.

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    what it means is that the planning and management fee standard rebate has increased to $306.30, if you are over the threshold after the account is paid in full, you can get up to an additional $203. So the most you will get back combining rebate and capped EMS benefit is $508.30

    so yes the standard rebate has almost doubled, but the rule of getting 80% of out of pocket expense back no longer applies for obstectric/art service, rather there is a cap on the out of pocket expense that can be received in addition to the rebate.

  5. #5
    leajones22's Avatar
    leajones22 is offline Just when the caterpillar thought the world was over, it became a butterfly
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    What gets me is that when you say the fee is $1500 for the planning and management.....I had a ob of my choice through my public hospital but I chose him before the hospital and my fee was only $175 not anywhere near being over $1000 and he also delivers through the private system as well. I was also never charged for him being at the delivery of my child.

    Everytime after the first visit I was charged $50 and I got back $36 of it and this time I will get back $40. So it has gone up. All Up I probably was charged $600 from start to finish of my last pg with my ob and medicare gave me more than half of it back.

    How can having PHI be better if you are paying out over $100 a month in their fees and when you have a baby you pay your hospital extra and then if you have an epi you pay for the anithetist and you still have to pay well over $1000 just to have your OB aswell. Sounds like you are out of pocket lots to me, but that is not medicares fault.

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    Leajones, I think you're in the minority being able to pick an Ob to deliver at a public hospital. I have PHI precisely because I couldn't choose my doctor or have any kind of continuity of care. Around here, my choices were limited to going to a public hospital and being assisted by whoever was on duty or going private.
    Yes I am out-of-pocket. The changes will push a lot more people into the public system and I fail to see how this will actually save Medicare any money. Rather than reimburse me an extra couple of hundred dollars, it would mean paying for my entire pregnancy and hospital stay.
    I am not really out of pocket for standard Ob visits any more than I am for GP visits, so it's just the pg management fee that is the issue for many women.

  7. #7
    bgbgbb's Avatar
    bgbgbb is offline To think, I was only going to have 1 child!
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    Having just gone through my claim on the 31/12, and discussing this at great lengths with medicare beforehand, the situation is that the amount you get back initially from medicare is slightly higher, but your safety net claim is capped. Previously, you could claim 80% of your out of pocket expenses for your OB. Now it's capped at about $200. The reason being many OB's have been 'overcharging' as far as medicare is concerned for their services, which medicare feel is exploiting the safety net.

    So, all in all, despite how large your bill is, the most you would get back from medicare is under $500.

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    I took my claim in to Medicare for the preg & management fee today. I paid my OB $2000 and received $479.65 back.

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    Default Planning & Management Fee

    Hi all

    For some reason my OB's office did not mail out info on this Planning & Management Fee to me earlier when I said that I wnated to go private since I have private isnurance. So I wrongly assumed that it was a down payment for the OB's services at delivery. It wasn't until I rang Medicare this week to enquire about how much I would get back, that I was shocked to find out that this fee is covering for my care from 20 weeks up until delivery.

    The quote I got from my OB was $3800. Since it takes me over the safety net amount, Medicare said to expect approx $470 back. Since the service is not in-hospital, my private insurance has nothing to do with it. Medicare explained that this fee is only for private patients whether you choose to go into a public or private hospital.

    This fee covers all checkups and ultrasounds at the OB office from week 20 to delivery. I am at week 26 so only about 3 visits left: so far each visit is $100 and I get around $40 back from Medicare. The OB has an ultrasound machine in his office so I get to see the baby each time which of course is nice and comforting.

    Basically, this fee of around $3300 is for my OB to be on call in case I need any assistance BEFORE delivery. Delivery in hospital is yet another fee. As a private patient, even if your OB doesn't charge above the Medicare scheduled fee for delivery, you still have the partial cost of the anaesthetist (if you want the epidural), and extra ultrasounds and the paediatrician who will check on your baby before you can be released.

    If you plan to be a private patient (either in a public or private hospital), ask around for an OB who doesn't charge this fee as not all do. If the OB doesn't have this fee and doesn't charge over the scheduled fee for delivery, you may be out of pocket $600-$1000 for being a private patient in a public hospital. You will still get the benefit of your own OB all the way through and get your own room.

    As for me, I have managed to find a local OB to take me on as a private patient in a public hospital. It was a frantic search over 2 days of constant phone calls to friends and OB offices. So relieved!

    Hope this helps.

  10. #10
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    I only pay for OB visits and my high risk ultra sounds after my big 20 week $2000 fee. As soon as I go to hosp to have my c-sect I pay nothing my phi pays everything. My pregnancy and the birth of my son cost $20,000 all up, I only paid bout $3500 and would have been even less if I didn't need so many ultra sounds. Private health is definatly worth the $$!! Also you don't need full private hospital cover you can take out maternity cover by it self which is heaps cheaper
    I wouldnt go to any public hospitals where I am in south Perth I have been treated like crap too many times by the doctors in public hosps here.


 

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