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Private patient in public hospital - please explain?


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#1 JomoMum

Posted 27 May 2019 - 08:00 PM

I’m really not sure how this works .. If I don’t have pregnancy cover, how can I use my PHI in a public hospital to give birth?

I would love to do it. I’ll be having a c section this time so would love to have a familiar Doctor on the day, but I can’t figure it out.

Please explain!

#2 just roses

Posted 27 May 2019 - 08:05 PM

I’m pretty sure you can’t, OP. If you don’t have pregnancy cover then you won’t be covered. But you could potentially pay out of pocket for a private OB in a public hospital. It wouldn’t involve your PHI, though.

#3 Mands09

Posted 27 May 2019 - 08:06 PM

If your health cover doesn’t cover pregnancy then you can’t use it even in a private hospital as your admission won’t be covered by the fund. Just go as a public patient.

#4 smmaho

Posted 27 May 2019 - 08:08 PM

Not sure how it works however even when I didn't have pregnancy cover my fund stated that I was able to have my baby in a public hospital but using my private health insurance. I ended up upgrading my cover and went private.

#5 Caribou

Posted 27 May 2019 - 08:14 PM

You need to check with your health cover. But some of my friends were able to use PHI to pay for a private room, while still using a public OB. Otherwise it’s good for a public hospital to be able to use PHI of patient, the hospital gets funds from PHI rather than using public funds. Hospital really appreciate this as funds are always tight.

#6 Soontobegran

Posted 27 May 2019 - 09:08 PM

View Posttayto..., on 27 May 2019 - 08:58 PM, said:

I used my (basic) hospital PHI in the public hospital for each DD. As far as I could tell the main “perk” was the chance of being top of the list for a private room, so long as others didn’t have clinical need for it. But yes the hospital love it and a nurse told me that they use $$ for education, so I was happy to use it.

How long ago was this tayto ?

#7 Soontobegran

Posted 27 May 2019 - 09:13 PM

Just need to make it clear that in the public system single rooms are single rooms and not 'private' as such so unless all rooms are single ones they will not necessarily go to those who have PHI.
They are allocated according to need so C/S, sick mums, sick babies, multiple pregnancies, pregnancy loss, social issues all came before PHI at my place of work.

I think the main benefit for being private in public is that the hospital gets paid from 2 sources rather than 1.

#8 ipsee

Posted 27 May 2019 - 09:42 PM

It works differently for different hospitals, as well as different doctors and health providers so you need to find out what your area offers.

Some people have used it to enter the private part of the hospital after the birth (in a hospital which has both public and private).

Others get no benefit, but the hospital charges the private health cover.

I found it was a negative. I was in the public room, but the staff didn't pay much attention to me as I was supposed to be under the care of my private obstetrician - who I also barely saw.

#9 just roses

Posted 27 May 2019 - 10:03 PM

But I think OP is looking to have a familiar (private) OB using PHI in the public system although pregnancy cover, and surely that’s not possible. But could she pay privately for an OB within the public system?

#10 ipsee

Posted 27 May 2019 - 10:11 PM

My Ob worked in the public and private system in the same hospital and said if I went public he could try to get me onto his books. no guarantee though.

#11 Soontobegran

Posted 27 May 2019 - 10:25 PM

View Postjust roses, on 27 May 2019 - 10:03 PM, said:

But I think OP is looking to have a familiar (private) OB using PHI in the public system although pregnancy cover, and surely that’s not possible. But could she pay privately for an OB within the public system?

As far as I know unless you have pregnancy cover with your PHI they will not cover obstetric care at all which would mean you are not really private in public unless you are willing to pay all the obstetricians costs privately.

I know my daughter had PHI but not pregnancy cover ( unexpected pregnancy ) and it was just not going to be possible financially to do it. She certainly tried to wangle it.

My experience is only with a very large tertiary women's hospital so I am not sure if the same stands with smaller or regional places.

#12 José

Posted 28 May 2019 - 07:23 AM

View Postjust roses, on 27 May 2019 - 10:03 PM, said:

But I think OP is looking to have a familiar (private) OB using PHI in the public system although pregnancy cover, and surely that’s not possible. But could she pay privately for an OB within the public system?

This is my thoughts.
The hospital might get funds from your insurer if you go in as a private patient, but that benefits the hospital, not the patient.
I think the benefit of private patient in public hospital is minimal and can’t imagine it would cover a private OB.
Really, isn’t that why many people have private health insurance for pregnancy.? They want a consistent care team/ dr?


#13 400

Posted 28 May 2019 - 08:11 AM

As I understand it, these are the possible routes:

100% public

100% private: pay for OB visits throughout pregnancy and PHI covers hospital stay in private hospital.

Public care but with PHI: usual public care throughout pregnancy and in hospital, but public hospital receives funds from PHI rather than government. Insignificant difference in care from patient point of view, with (very) small chance of perks e.g. private room, capacity/needs dependent. Benefit is reducing financial burden on public system and small chance of private room.

Private (OB) in public (hospital): pay for OB visits and seen in private clinic throughout pregnancy, stay in public hospital under care of private OB rather than the public doctors. I’m unclear if funding is PHI (and whether basic covers it) or government. Perks are continuity of care, but the overall care may be less than you would get if public as the public doctors in the hospital will be very much hands off and only get involved in the case of an emergency. This mode of care is popular in overseas visitors ineligible for Medicare (since they are not eligible for public clinics anyway and public hospitals are cheaper overall) and those who have previously had kids privately and want to stay with the same doctor but no longer have obstetrics PHI.

In my opinion, the two benefits of private care are 1) continuity of care with private OB, but you pay for it regardless of care mode or PHI, and 2) staying in private hospital but you need appropriate cover for PHI to pay for it.

#14 JomoMum

Posted 28 May 2019 - 08:42 AM

Thank you everyone for the all info. I would assume that if I’m not covered for obstetric care in a private hospital, then I wouldn’t in a public either. But given the disparity that then possibly causes, I don’t think I’d want it anyway.
I am anxious about being in a large shared room for some various reasons, but I’ll just have to see how we go.

Edited by JomoMum, 28 May 2019 - 08:43 AM.


#15 Crazyone26989

Posted 28 May 2019 - 10:00 AM

View PostJomoMum, on 28 May 2019 - 08:42 AM, said:

Thank you everyone for the all info. I would assume that if I’m not covered for obstetric care in a private hospital, then I wouldn’t in a public either. But given the disparity that then possibly causes, I don’t think I’d want it anyway.
I am anxious about being in a large shared room for some various reasons, but I’ll just have to see how we go.

What public hospital would you be looking at?

RPA in Sydney only has a few shared rooms and they are only two to a room.

#16 Crazyone26989

Posted 28 May 2019 - 10:01 AM

View PostJomoMum, on 28 May 2019 - 08:42 AM, said:

Thank you everyone for the all info. I would assume that if I’m not covered for obstetric care in a private hospital, then I wouldn’t in a public either. But given the disparity that then possibly causes, I don’t think I’d want it anyway.
I am anxious about being in a large shared room for some various reasons, but I’ll just have to see how we go.

What public hospital would you be looking at?

RPA in Sydney only has a few shared rooms and they are only two to a room.

#17 dreamweaver80

Posted 28 May 2019 - 12:18 PM

Hi OP,

Just sharing my experience as I had a c-section as a private patient in a public hospital last year (RPA in Sydney if that helps) Should mention I have no experience using private hospitals at all so this is fairly one-sided.

We don't have private health insurance at all although I had rang up to enquire with insurance companies well before we started trying. We had to do IVF so I wanted to know if there were any advantages having PHI for that as well but that's a different story. Basically, one guy talked me out of getting it if only for pregnancy cover as it only really helps financially with the hospital stay. Since I'm not particularly bothered about staying in a private hospital with better food options and perhaps more attention from nurses, our decision was to not go for private insurance.

I did however want a private OB as it was my first pregnancy and being an IVF one after a few losses, I just wanted the same person looking after me the whole time, including at birth. Our OB had a few hospitals where he delivered and 2 are public, I've heard that not all OB's do give that option. On top of the OB fees, the extra cost is obviously paying for the hospital stay. We had to pay upfront for 5 nights and chose the shared room option, which was much cheaper than a private room. I ended up needing a c-section so automatically went into a private room but only stayed for 3 nights so I got refunded the price of the extra 2 nights. I honestly don't know how they could put a c-section patient in a shared room as you definitely need someone to stay with you and baby constantly that first 24 hours when you're confined to bed!

One thing we got hit with was the bill for the anaesthesist fee, the reason I was given was because 'I was a private patient'. I was literally getting wheeled into theatre when that landed on me so no chance to really question it. That was over a $1000 if I remember.

I had no regrets about my experience as a private patient in a public hospital as I feel like I was given a good standard of care by my OB and all the staff at the hospital. That being said, it's still expensive going that route when everything gets added up.  I'm pregnant again now and going 100% public as we just aren't in the same financial position without my salary.  Got into the midwifery group program at a different hospital and will see the same senior midwife (at my house) the whole pregnancy and extra visits with doctors as I'm considered high risk. So far I'm so happy with the care and attention and going to especially love having the extra money at the end!




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