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  1. #1
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    Unhappy BUPA Minimum benefits - Private vs public

    Hi everyone,

    So I was going to upgrade my private health fund cover today to cover all pregnancy costs, but discovered that there's a 12 month waiting list! I understand why this exists, but to me still seems to stupid as you don't know when you're going to fall pregnant, especially if you haven't planned to start trying.
    My current hospital cover states that I get "minimum benefits" for pregnancy cover. Does anyone know what this means, in as far as what I get back?
    I wanted to have the baby at Newcastle Private hospital, but not if it costs me and arm and a leg to do so!
    I just feel a bit stressed now and have no idea what to do, as I've been looking at reviews for John Hunter, but they're all mixed so I am at a loss here.
    Anyone have any advice!?

  2. #2
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    Hi

    yes there is always a 12 month waiting list for obstetrics - as otherwise people would wait until they were pregnant before paying for any insurance.

    My suggestion would be to call your PHI provider and ask exactly what is included in your cover - and what excess etc you will have.

    Its different for every provider, for every level of cover and especially for every obstetrician as they all charge different fees over the schedule amount.

    best wishes with your pregnancy - and I hope your current level will cover you.

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    I had limited cover for obstetrics with AHM.
    I was treated as a private patient in a public hospital.
    I had my own room - providing one was available.
    Different menu - with different options
    Own obstetrician
    I paid an excess of around $500 for the hospital and around $1600 out of pocket for the Ob.
    To be honest, I liked the private room - which I may have gotten as a public patient. And I liked my Ob. But no doubt, the Obs at the public hospital would have been great too.
    If I had the same limited cover again I wouldn't have bothered.
    Check with your provider about what they actually cover

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    I've been attempting to look into this also but it's very confusing. Have had cover for 12 months so not fussed in waiting periods, however the more I read up about it all the more I realise that there will still be plenty of out of pocket costs if we go private.

    2 close friends have had no insurance, and both went public in two diff Victorian hospitals and both rave about their experience with $0 out of pocket.

    I'm starting to think the $160+per month for insurance would be better off in my savings account..... But then there is always the "what ifs" that creep in.

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    I think BUPA and other providers have changed their hospital cover for pregnancy/obstetrics.

    The highest cover is for all IVF/FS procedures. And the step down is for pregnancy/birth only.

    Maybe check T&C but I only paid excess and that's it. Was in a private hospital for 3 or 4 nights.

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    12 months is the normal wait period for all phi in relation to anything in a hospital.

    It doesn't meant you can't start to ttc after 4 months as by the time you have bubs you would of gone past the wait period.

    You will have a ob gap and a paed gap for going private that is normal. Phi doesn't pay for those things at all.

    In relation to your minimum benefits I would call up Bupa and actually ask them what it means and if you will have a gap and or co-payment for being in hospital for X amount of days.

    You can also choose to not have a family/couples policy with your dp/dh not being on the policy as this will reduce your premium aswell and just have a singles policy that covers obstetrics

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    I have restricted obstetrics cover on my private health. With my first pregnancy I was low-risk and went through public through the midwifery group practice. I had the same midwife from 20 weeks, it was great and it cost me nothing.

    This pregnancy has been awful and I am high-risk, so we decided to go with a private Ob so I had continuity of care instead of going through public where I would have seen many Ob's and other specialists. The Ob fees are not covered by health insurance at all for anyone, and you will be out of pocket for a management/birth fee which will be in the thousands plus consult fees. You will also be out of pocket for ultrasounds, and if you birth at a private hospital you will need to cover any gaps by drs there as well (paed, anaesthetist if required etc) - this will depend on your hospital, drs and level of healthcare).

    My limited obstetrics cover doesn't mean all that much, basically I can choose my Dr but I can't birth in a private hospital which doesn't matter to me. I am birthing in a public hospital as a private patient. I still need to pay the excess, but the important thing to me was that my Ob would come and deliver at the public hospital for me knowing my history in full detail and be in regular contact with my other private specialist about my pregnancy care. I don't care for any other private "perks" (of which there are few - the rooms in my public hospital are already singles anyway) but I will have no other out of pocket costs for the hospital stay, paed, surgery, anaesthetics etc as this will all be bulk-billed once I am admitted. Best of both worlds IMO.

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    @Pearlygirl thank you so much for all that info xx

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    Pearlygirl  (01-03-2017)

  10. #9
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    Thanks everyone for your replies!
    It's all just so confusing and I have no idea about any of this insurance stuff and it feels like a lot to take in!
    I feel like it should be made more widely known about the 12 month waiting period. Unless it is and I've just been living under a rock? Haha.
    I think that if you've already got insurance with them (and have had it for the last 5 years) that it should count for something and at least minimise some of the wait!

    I called Bupa to see what's covered and was told that I can go to a public hospital as a private patient, and they only cover the hospital fees ($100 per day, capped at $500) and they'll only cover the OB if they charge me as a 'no gap patient'.

    I guess I just have to hope now that I'm lucky enough to get a private room and that my experience at John Hunter isn't a negative one!


 

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