Due date 1 day over PHI waiting period - will we still be covered??

**becandabub** · 11-08-2012 03:28

Originally Posted by Tamtam

I can't be sure but I'm going to say no. I investigated this question myself. We are with medibank. When I rang and asked they said no. We upgraded our OB cover and it's waiting period is up in October. Our bub is due December. We were worried about getting pregnant too close to waiting period date too! But you could ring and check.

What are they taking your premiums for if you are several months outside the waiting period & they still won't cover you?! That makes no sense at all.

**Tamtam** · 11-08-2012 08:18

Originally Posted by becandabub

What are they taking your premiums for if you are several months outside the waiting period & they still won't cover you?! That makes no sense at all.

Initially we were going to try and get pregnant earlier and if it had worked the due date would have been very close to the end of waiting period. After talking to medibank and being informed that if baby came even a day or so before they would not cover us we decided to hold off for another two months just to be sure we'd be covered and there would be no issues. I probably didn't explain that clearly.
As far as I know it's about when you access the hospital and obstetric services in labour. If you haven't done the full 12 months wait they won't cover any of that. And you could arrive at hospital, have your baby and be lumped with a huge bill! We didn't want that ugly surprise. The EDD had no bearing on the waiting period. It has to do with when you actually go to hospital. But all funds are different.

**CD84** · 11-08-2012 15:53

Originally Posted by becandabub

What are they taking your premiums for if you are several months outside the waiting period & they still won't cover you?! That makes no sense at all.

My thoughts exactly! I went into Medibank today and asked the lady there (our 12 month waiting period is actually over on 19 April 2013 and our due date is 21 April 2013). And I asked her what would happen if the baby came on 16th, 17th or 18th April 2013 and she said as long as your doctor can provide a letter stating what you due date was then we will be covered. I also sent Medibank an email asking this and they replied with the following .... it may be useful for others in the same situation?

"Thank you for contacting Medibank Private.

A 12 month waiting period applies to obstetric services before benefits are payable. Your waiting period will be served as of 19/04/2013.

However, benefits are payable during this waiting period for premature births and complications arising from the pregnancy where a medical practitioner confirms that the baby was not expected to be born until after the waiting period.

If you require any further information relating to the obstetrics waiting period, please contact our Customer Care Line.

Thank you for your continuing membership with Medibank."

**melancholic** · 05-11-2012 22:13

Hello everyone!

Does anyone know if BUPA will let you use your pregnancy cover based on the baby's expected due date rather than the actual birth date?

I am also in a predicament as my waiting period expires only one week before the baby's expected due date. I would like to go private but am so worried the bub will arrive early and I will have to fork out private hospital fees!

Otherwise I'll probably try to get into RPA public hospital as it is the closest to where I live... But then what if the bub arrives on time/late and I don't get to use my private health cover that I've paid so dearly for?

Does anyone know how it works... can you book into private hospital and if the baby comes before waiting period expires, can you switch to public?

Any feedback is much appreciated! It's my first pregnancy and I am feeling so anxious!!

Thank you!

**Bubintummy** · 06-11-2012 01:54

I'm with RT health and had to get a letter of proof from my ob as my baby came early. However I'd held top hospital and extras for years, they just like you to upgrade to family cover 8 weeks before EDD (which I had done.. Just) so not sure if that makes a difference. All was fine in the end which I was thankful for as on top of my week long stay my bub was in SCN so I can only imagine the kind of bill I would have copped!

**millsmum** · 06-11-2012 21:48

Originally Posted by CD84

We are looking at going as private patients in a public hospital, and our calculated due date is 21 April 2013 and our PHI 12 month waiting period finishes 20 April 2013 (we joined 20 April 2012) .... are we still covered, even if the baby came early? Is it as long as your doctor has your due date in writing that you will be covered?

Thanks

Hi, I was just wandering if you still have to pay an excess when going private in a public hospital. I rang our provider medibank to ask how private in public works as our private hospital no longer has a maternity unit and they told me I would still pay an excess, does this sound right?

**melancholic** · 07-11-2012 05:53

Thank you, bubintummy. I will ring up BUPA and see if they are willing to honour my EDD instead of the actual birth date. Fingers crossed!!!

Millsmum, yes that sounds about right because you will still be admitted as a private patient in a public hospital. So you need to pay excess per your PHI policy.

**littleriv** · 07-11-2012 06:27

Hi Melancholic, congrats on your pregnancy. Do you have a private OB? I am with Bupa. For my most recent bub (DD is now 3 months old), I had private health insurance, but not the obstetric extra (as I thought we had finished having babies and I let it lapse years ago). So, I had basic private hospital cover, but not obstetric cover. I rang Bupa and they said, no, I wouldn't be covered this time as bub would arrive before waiting period had expired. I had first 2 bubs at POWP, with a private OB, and full obstetric cover- I had to pay an excess, but that was it. This time around, I had the same private OB (who delivers also at RPA) and he suggested RPA for me this time. I only had to pay a small amount to have a private room- $200 per night from memory, and no excess- and I was a private patient- BUPA covered the rest. RPA was excellent, and I had my private OB as per usual, and I was treated as a full private patient. Ring Bupa right away and try and get a definite answer in writing, not just verbal. If they can't guarantee you will be covered, you may choose to go with RPA (which was excellent, in my experience). From the inquiries I made, there was no way I could have afforded to attend the private hospital without the full cover. It would have been $$$$$$. All the best

**melancholic** · 09-11-2012 06:18

Hi littleriv, no I don't have private OB. My GP only confirmed the pregnancy yesterday and I am due for my first 7 week ultrasound in two weeks time, so I haven't organised anything yet.

Plus I thought if Bupa doesn't cover me for this pregnancy I need to go public at RPA. My GP has said good things about RPA and he's also registered for shared care with them, so I am already starting to feel ok about it.

Sorry I am a little confused.. you said you did not have obstetric cover but went in as a private patient at RPA and BUPA covered everything but your room cost? Is obstetric cover separate from normal pregnancy related services?

If you don't mind could you PM me your OB's details?

Thanks a bundle for all your help!