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Private Health Insurance - a few questions


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#1 bide

Posted 27 October 2015 - 01:39 PM

Hey everyone,

I'm looking to get some private health insurance (just basic hospital cover for now) but I'll be trying to conceive in about a year's time, and I wanted some info on private health insurance cover for pregnancy.

I guess I'll start from the beginning... what's covered under private health insurance? Do I just get a 'private' room in a private hospital? (doesn't really seem worth it if that's all?!)

Is the public health system ok? Anything I need to keep an eye on?

I'm also wondering if there's any difference between the providers I choose. I'm in Victoria, if that makes a difference.

#2 Sassenach2

Posted 27 October 2015 - 01:51 PM

Private hospitals are much better than Public hospitals in my opinion. Of course it depends on where you are and what the local public hospital is like.
If you have a Private hospital, you can stay in longer and learn to breastfeed properly and yes, they try to find you a room of your own and I think our local private maternity hospital, only has private rooms. The care is much better as the nurses are not run off their feet, as public nurses and midwives are. I loved staying in hospital longer to get meals brought to you and not worry about the housework, so I definitely go with Private cover and if your father or grandfather was in the Army at any stage, Defence Health is the best.

#3 MrsLexiK

Posted 27 October 2015 - 01:54 PM

For me I wanted to see the same OB. I wanted to be able to phone at x time and be listened to. I didn't want to be pushed out after 6 hours. I wanted my DH to stay over night. Second time I also wanted a choice in VBAC or csection, I felt more comfortable with seeing the OB I had seen as he knew my history. I again wanted my DH to stay and to be in for 5 nights. (Through my private I also was offered LC and midwifery follow up care)

I went to a low gap OB, his management fee was low ranging from )685-$1100 (depending on health fund and which hospital.) second time around it was $535 I think - discount for second birth maybe?

I haven't received but expect to receive anthesist bill last time it was around $200 and I only received the outstanding part (they claimed medibank and Medicare for me).

Bloods were all bulk billed bar the 12 week one but it isn't bulked bill in Vic anyway (you maybe able to get the scan bulk billed) both boys I have had a minimum of 4 scans I think I had 6 with DS2. I had to pay for these and then got Medicare but I was out of pocket.

I just got my receipt for my stay they paid out $11k plus for my stay. I feel good that I was able to save Medicare that amount.

My private hospital only has private rooms. Cabrini had shared rooms as well private so no gurantee.

#4 MrsLexiK

Posted 27 October 2015 - 01:56 PM

Also as DS1 was admitted himself I saw no bills for him (be was visited by the paeds multiple times a day plus the attendance at birth). DS2 as he was csection needed a paed at birth and then a follow up it was over $500 which Medicare paid a chunk but as we had hit the limit back in March the chunk was a big chunk not sure how much we would have gotten back if we hadn't hit the threshold.

#5 bide

Posted 27 October 2015 - 02:02 PM

Thanks so much for your replies.

Definitely sounds like private is worth it, then - I'd like to be seen by the same doctor for all my visits and I'd like nurses to be patient with me, since it'll be my first I'll have a ton of questions.

I didn't realise the scans and OB/Gyns run up so high. Are any of them covered by the public system at all?

My DP lives in Templestowe but we'll probably be living in Croydon/Ringwood area by the time I'm hopefully pregnant, and I only moved to Melbourne a couple of years ago so I'm not 100% familiar with the hospitals in these areas.

I'm looking at getting either Medibank, HCF or NIB as they have affordable plans for my situation. Does it make a difference who I choose to go with or are they all same-same?

#6 Stoked

Posted 27 October 2015 - 02:20 PM

I'd be looking at different insurance providers only to check who has the most affordable premiums for the level of cover you want. For example, Medibank has mid-hospital with obstetrics but you can only get that if you get extras with them as well. Pretty much every health insurance provider has obstetrics cover now only included in their top hospital cover which is pricey.

What you get:

1) You get to choose the hospital you deliver at - you can tour private hospitals' maternity wards and pick the one you like

2) You get to choose the obstetrician you want - as long as they practise in the hospital of your choice, of course.

3) You get continuity of care with your OB throughout the pregnancy and for at least 6 weeks after the birth, more if needed. They are basically on call for you during that time.

4) You get to stay in a swish private hospital where your DH can stay with you and be fed decent meals etc., longer than you would have stayed in public, you are statistically more likely to breastfeed successfully but also statistically likely to have more interventions at birth.

Now what the insurer pays for is your stay in hospital (~$1000/day), the gap payment for the actual birth (75% is paid by Medicare, it's the 25% that the insurer pays - not much, a few hundred dollars if I remember correctly). And obviously if the baby is admitted and needs hospital care Medicare and the insurer will share the cost of that as well (unpredictable, can be very high $$$)

By going private, you will also be sent private for all your scans, some or all of the blood tests will not be bulk billed, of course there are OB fees to pay as well and it really adds up. My first birth I was out of pocket for about $8K ($5K for obstetrician, $800 hospital excess, scans and tests, physio, etc. ate up the rest). My second birth (same hospital, same OB) I was OOP about 6K. Easier birth, not so many scans and tests, no need for physio, OB charged lower fees.

So $14K for two children. That is on top of paying approx $1200-1500 a year for 8 years of obstetric cover on my health insurance. Eeek.

#7 Stoked

Posted 27 October 2015 - 02:29 PM

View Postbide, on 27 October 2015 - 02:02 PM, said:

I didn't realise the scans and OB/Gyns run up so high. Are any of them covered by the public system at all?
Well you do get back something but it's not a lot. My OB was around $4K out of pocket last time and another grand or so was charged to Medicare. If you find a 'no gap' OB that means all he gets is what Medicare thinks he should charge.

#8 bide

Posted 27 October 2015 - 03:12 PM

Thanks for the heads up, Stoked. I'll start setting aside some money in my budget for this.

View PostStoked, on 27 October 2015 - 02:29 PM, said:

So $14K for two children. That is on top of paying approx $1200-1500 a year for 8 years of obstetric cover on my health insurance. Eeek.

Ugh I know! So frustrating how expensive it all is.

#9 lucky 2

Posted 28 October 2015 - 07:57 AM

There is absolutely no guarantee that "you will get better care" in a private hospital. That is a ridiculous statement.

#10 Soontobegran

Posted 28 October 2015 - 08:22 AM

View Postlucky 2, on 28 October 2015 - 07:57 AM, said:

There is absolutely no guarantee that "you will get better care" in a private hospital. That is a ridiculous statement.


Was about to say the same thing.
There are private hospitals around severely lagging behind some public in the aesthetics department if that is why you want to go privately.

Public hospitals generally have more staff and access to better equipment and more specialised staff being on hand.
Many public hospitals have midwifery led programs which affords continuity of care if that is what you want.
Newer public hospitals have more single rooms too.

If you feel you need an obstetrician and you want a longer stay in hospital then private will usually assure you of this but even then the obstetrician isn't always present for delivery and waiting for an epidural if needed is common.

The one plus I do believe is that the longer stay does help with establishment of breast feeding in many women.

I worked in public but delivered privately because at the time I had my babies there were too many 4 and 6 bed rooms and sharing was not my thing.

#11 Soontobegran

Posted 28 October 2015 - 08:24 AM

OP there are obstetricians in the Eastern Suburbs who do not charge $4k or more for their management fee.

#12 Burro

Posted 28 October 2015 - 08:30 AM

i think there are some big wobbly generalizations in this thread.

First thing, work out which public maternity hospital you would be zoned for. Australia has some of the safest public maternity care in the world so i wouldnt be rushing to spend $8000 x2 for an extra couple of nights and some posh salads unless i had cash to splash and no mortgage or the public offerings were actually less safe.

Public hospitals usually have excellent breast feeding support, and often have better facilities and staffing should you or the baby need specialist care. Many offer a midwife program so you will be familiar with the person helping you birth.

Obstetricians are surgeons and there is a good chance you may not need one. If you do need one for surgery they will be masked up and busy working at the opposite end to your face. Id rather a relationship with a midwife or a private doula. Theres no guarantee your surgeon will be available anyway, or wont have other pressures on their time when you give birth.  

another option is shared care with a GP so you can see the same dr before during and after the pregnancy with the baby. Just not the actual birth.

Some public hospitals also have private rooms and good food.

If i were you i would post here asking for reviews on your local public maternity hospital. If they are terrible, start saving. If people have had good experiences, stick your spare thousands of dollars on your mortgage or have a luxury tropical holiday when you have recovered.

I went public and When i think back to my first few days with my new babies it wasnt the menu i treasured. And while it would have been nice to have my partner there the midwives and nurses were probably more useful for establishing breastfeeding.

good luck

#13 nup

Posted 28 October 2015 - 08:32 AM

My friends who have birthed privately have not had the same standard of post birth care that I've received in public. I now worry about friends birthing privately not getting any breastfeeding support as I've seen how non existent it can be.

Take a tour of your local hospitals and ask to speak to midwives about the care they offer. I was genuinely surprised by our local public hospital. It all depends on how busy they are, but the same applies to both private and public. If you have an emergency you'll likely end up in public anyway.

ETA midwives all the way and I've needed emergency intervention in all of my births. The obs shows up when they're needed which hopefully they won't be.

Edited by nup, 28 October 2015 - 08:34 AM.


#14 LozS

Posted 28 October 2015 - 08:33 AM

I went private with my first because it was all unknown for me - I was over $5k out of pocket - and the follow up care following a day 3 discharge was non-existent. I went public through midwife care with my second, $0 out of pocket and I felt so much more supported despite a (self-requested) 6 hour discharge.

My allocated midwife (who I saw for nearly every appointment throughout pregnancy) came to my house every day for the first 4 days after birth, then every second day for the first 2 weeks, then weekly the next 2 weeks. That was 4 weeks of support, as opposed to private where, as soon as I was discharged I was on my own.

If you go private, you need to be aware that PHI only covers ob costs after you have been admitted. All appointments prior to delivery, as well as the pregnancy management fee are excluded from private health coverage. You do get some back from medicare but the rebate for the pregnancy management fee is capped at $450ish.

You may also want to look for an ob who offers "no gap" with your health fund so you are not out of pocket at delivery as well. Some other potential hidden fees are the anaesthetist if you get an epidural and/or need a c-section as they may charge a gap as well.


#15 Burro

Posted 28 October 2015 - 08:37 AM

Also, work out what you might pay in premiums for years of PHI for maternity.

#16 nup

Posted 28 October 2015 - 08:38 AM

When these threads happen I'm always astonished that people willingly fork out these outrageous fees. I know why they're so high, but don't understand how they're deemed necessary for so many women. I've had friends who've paid the outrageous fees and they feel perfectly justified, when there are far more affordable options available. It seems to be about status amongst the people I know. I've even had one friend tell me she didn't want a horridly disfigured vagina. Midwives for births unless you're in a high risk category. And that's a very small percentage of women. But apparently I only know high risk women.

#17 nup

Posted 28 October 2015 - 08:40 AM

And no one mentions the upsell that happens in private hospitals.

#18 SeaPrincess

Posted 28 October 2015 - 08:44 AM

I think I was most appreciative of having PHI when things didn't go perfectly. I was admitted 3 times and spent a total of a month in hospital when pregnant with DS2. Cost me nothing, PHI paid out over $25K. I had a private room the entire time, so I wasn't worried about disturbing anyone else when DS1 visited, and when my water broke, I wasn't pressured to deliver within 24 hours. In my next pregnancy, our local public hospital was an hour away by plane, but I chose to fly interstate to where my parents live and deliver in the same hospital. We had to pay for flights, but I'd have had to fly Mum up to help me from 34 weeks anyway as DH wouldn't have been able to come until much closer to my due date.

#19 CallMeFeral

Posted 28 October 2015 - 08:48 AM

I'm sorry but there is some awful misinformation on here (sorry lucky2, I'm out of likes but consider your post 'liked'.

View PostCopper and May, on 27 October 2015 - 01:51 PM, said:

Private hospitals are much better than Public hospitals in my opinion. Of course it depends on where you are and what the local public hospital is like. If you have a Private hospital, you can stay in longer and learn to breastfeed properly and yes, they try to find you a room of your own and I think our local private maternity hospital, only has private rooms. The care is much better as the nurses are not run off their feet, as public nurses and midwives are.  

So this is bollocks. Or rather, may be true in some cases (if the public hospitals in your area are dodgy), and desperately untrue in others.

My PUBLIC hospital had all single rooms except one (and I haven't heard of the shared room being used). It was new and had wonderful facilities. Yes you don't get to stay as long (some people like that). And I expect the food is not as nice - I don't really like hospital food anyway so it's kind of moot for me.
Meanwhile people have had shared rooms in PRIVATE hospitals in our area, after paying all that money.
The nurses and midwives in our public hospital were absolutely wonderful apart from one or two duds - which is the same as I've heard from private hospitals. Probably because they are people, and there are always going to be some good some bad. I never felt like my midwives were rushed. Anaesthetists yes (but this is often because they are shared with private/public hospital), but not the midwives where I was.
And the care will be better if the public hospital you are at is a tertiary one, not all privates are, and they would then transfer you to the public anyway if there were an emergency.
And the lactation consultant at our public? Legend. And as a public patient I could come back and see her whenever I wanted (and I did) without paying - unlike private.

Of course, public can be worse - some public hospitals are awful.

What you DO ALWAYS get with private is your choice of obstetrician, choice of a c section that's not medically required, and a lot of extra costs. You need to decide whether the ones offset the other.

Best thing is to look at your local publics and privates and see what they are like, and make your decision from there. Maybe also what ob you would want.
Then look at which insurance companies they are partnered with - some have 'no gap' arrangements with certain hospitals/obs, so you would have more gap with some than with others.


View PostMrsLexiK, on 27 October 2015 - 01:54 PM, said:

For me I wanted to see the same OB. I wanted to be able to phone at x time and be listened to. I didn't want to be pushed out after 6 hours. I wanted my DH to stay over night. Second time I also wanted a choice in VBAC or csection, I felt more comfortable with seeing the OB I had seen as he knew my history. I again wanted my DH to stay and to be in for 5 nights. (Through my private I also was offered LC and midwifery follow up care)


I stayed for 3 days at my public. DH stayed overnight (albeit on a fold out couch, not a bed). I could call the midwife team at any time and be listened to. I saw the same midwife throughout both my births, who was the most lovely person, and knew my history. I had LC and midwifery follow up care. All free :)

#20 RockyV

Posted 28 October 2015 - 08:51 AM

I've had all of my babies in a public hospital. The care was high quality and it cost me nothing. My babies had to be in NICU for a short period. Cost me nothing.

The short stay was something that initially bothered me but the care in the home with the follow up midwife / MCHN program was more valuable and I was relaxed in my own setting.

I looked up the cost each time for private cover and it was astronomical. Ultimately you are paying for nicer curtains and better food. Yes, you get to choose your obs, but it all comes at a pretty high cost.

You are not paying for better care.

A recent situation at a popular hospital that has a private division as well as public part was told to me by a nurse who is high up in paediatrics. The baby was born in the private section and had complications. It wasn't until a nurse from the public area eyeballed the baby that she alerted some major issues and the baby was quickly transferred to the public care unit. They are much more exposed to problems and used to dealing with them. The private divisions are usually for straight forward stuff - not to frighten you off but any major emergencies - you'd want to be in the public health system.

Good luck!

#21 CallMeFeral

Posted 28 October 2015 - 08:59 AM

View Postnup, on 28 October 2015 - 08:38 AM, said:

When these threads happen I'm always astonished that people willingly fork out these outrageous fees. I know why they're so high, but don't understand how they're deemed necessary for so many women. I've had friends who've paid the outrageous fees and they feel perfectly justified, when there are far more affordable options available. It seems to be about status amongst the people I know. I've even had one friend tell me she didn't want a horridly disfigured vagina. Midwives for births unless you're in a high risk category. And that's a very small percentage of women. But apparently I only know high risk women.

To be fair, a lot of it is fear. First birth I did hypnobirthing and the rest, and thought I would just 'breathe out' this baby with the help of a bath and midwife, as nature intended. Little miss posterior didn't go anywhere (nor did my cervix) after 30 hours of labour, and I think I was saved from a caesar by the wonderful (public) obstetrician who manually turned her, and then helped her out via forceps when she went into distress.

It made me scared for subsequent births, because the ob before him was an awful cow, and I felt that if she'd been on instead, I'd have had to have a caesar.

It wouldn't be enough to turn me private normally, because a random ob is no more likely to be wonderful than the random ob a hospital allocates me - but in this case I called up the ob and got his recommendation for who would be as wonderful as him, and went private after that. Total waste of money - DH delivered the baby in our bath at home. But it was a fear decision. And sometimes the worst happens - third birth I was private at public and was going to be the experiment for the the trainee anaesthetist, and I was terrified. Being private allowed me to say no, and her supervisor (grudgingly) had to do it. Knowing the complications that can arise from a bad epidural, I'm so grateful for this. But still, first time I had a perfect epidural in public by an experienced practitioner without having to pay for it. It's luck of the draw. You pay to have better luck at the draw!

#22 nup

Posted 28 October 2015 - 08:59 AM

Is private hospital food really worth it? I think all mass catering is pretty rank. People are talking as though it's worth paying for. The tertiary hospital closest to us has one of the best hospital cafetarias I know of. Would much rather have proper coffee, decent pastries and a selection of fresh made salads. None of the private hospitals I've been to have had food worth even mentioning. Where are all these well catered hospitals???

#23 bide

Posted 28 October 2015 - 09:00 AM

Thanks everyone for your answers. I didn’t realise I could tour hospitals to see their services, this really helps :)

I have some general questions from comments made in this thread:

For those who went public, how much were you out of pocket for?

Is it that difficult to learn to breastfeed? A few people have mentioned the longer stay helps with breastfeeding. Can someone please explain that a bit more? Why does a longer stay help with breastfeeding?

My main concern is, it will be my first full-term pregnancy (I had a miscarriage at Christmas last year) and seeing as it’s my first, I want the same doctor/midwife/nurse to see me all the way through. I don’t want to see different doctors at different stages who presumably would only skim through my file. Continuity is important to me.

Finally, can you choose which public hospital to go to or is it location based? I’m likely going to be in the Eastern Suburbs at that time (Templestowe, Croydon) or ‘north’ (Eltham, Yallambie) - still trying to buy a house so everything is up in the air. I hate real estate agents! But that's for another thread :)

#24 just roses

Posted 28 October 2015 - 09:03 AM

You need to compare apples with apples. Look at your zoned public hospital/s and compare it with the private options.

I gave birth privately both times. Mainly because I'd already been with my doctor through years of fertility treatment and felt anxious about continuity of care.

If we had a surprise pregnancy now, I'd go public. Our local hospital has an amazing midwife led birthing centre. You do leave early but you have your own midwife visit you daily for a week and then weekly for up to six weeks. That level of support is superior IMHO to what was available at my private hospital.

Here are some of my observations:
* Lactation support was limited at private. Yes, I had four nights and that helped. But there were several sets of twins born when I was there and I always ended up with someone different helping me. So lots of conflicting advice. I ended up hiring a private lactation consultant after being discharged.

* I liked having my own doctor. However, you need to be aware of how your doctor operates. My first private OB worked in a team and shared after hours care. I had a one in six chance of having him deliver my baby if I went into labour after hours. My second private OB did it all himself and would come in after hours. Personally, I don't think this is a safe way to practice medicine. And he actually said the same thing to me!

* Public hospitals tend to have more expertise on the ground in the case of emergency. If you go into labour early, you're likely to be transferred to a public hospital.

* Overall, the best thing was having a few nights in hospital in a private room. But now I'd be just as happy to go straight home and have my midwife visit me.

Be aware that you will need to have private cover before you become pregnancy. Well before, to be safe.

#25 jem_cat

Posted 28 October 2015 - 09:04 AM

Hi - it isn't about private being better than public, or vice versa.
Figure out which public hospital you are zoned for. Then take a tour, ask in detailed questions about their care - do you see the same midwife, how many to a room, breastfeeding support.
Then do the same for private hospitals in your area. Find out which Obstetricians deliver at them and ask around friends and on EB for recommendations.
I loved my OB and went private. I was happy with the delivery despite intervention , but the after care by the midwifes was non impressive. The breastfeeding support was terrible.
I recently spoke to a few people who delivered at the local public and they raved.
It is about what is important to you and what your area is like.




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