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Medicare Safety Net - Obstetrics no longer covered?


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#26 louise3now4

Posted 19 December 2009 - 02:30 PM

It is a hard one. 7 years ago when I had to book in for my first born, I was given a list of about 20 private OB's servicing all the private hospitals around my area. I rang every one. I was 4 weeks and 2 days pg so not far along. I found more than 50% were 'no longer delivering'. Sure some would manage the pregnancy but would not be there to deliver. Some had just left the business completely. And I am not talking about retirement. Of the remaining ones most had filled their books already. Mainly as they worked with IVF patients and were thus privy to the confirmed pregnancy earlier, or they had repeat patients. In any case I couldn't find one off the list. I ended up being given the name of my OB who had just started delivering. I was lucky enough to be her last one booked in for the month. Back then it cost me $1600, all of which was out of pocket because there was no medicare 80% rebate.
Fast forward two years, baby number two and we now have a rebate scheme. I think the fees had shot up to $3400 or something, a fair increase, but obviously not so bad for me as I was getting more back. I thnk I was still out of pcket the same amount $1600ish, but it didn't increase for me perse. The thing I did notice, was that friends and family who were falling pregnant around that time didn't have as hard a time finding an OB, there just seemed to be more practising or available?
Two years again, fees were now about $5500. I was going to be out of pocket $2700 this time, but I was lucky enough to get a $2000 discount from my OB as a regular repeat patient. Again, though it just seemed that getting in to see an OB was getting easier, despite the baby boom. I have to question if the rebate allowed more OB's to get back into delivering, as they could charge more and thus cover their massive insurance liability fees.

Right now two year on, I am pregnant again, and I have to pay the big bill this week, I am going to be paying $7500 for this baby. I will be out of pocket approx $3600. And this fee, as with all the others quoted above is just the pregnancy management fee. Not the tests, U/S's bloods, actual delivery fee, or for the anesthesiologist or paed. I am just making it in for the end of the year so will be gapped. If not I have not idea how it would have worked.

So yes, I have seen the fees rise and rise since the introduction. But it also seems (I do not know the stats) that there are more OB's available to women, as more can afford to practise. More money, more OB's. Private OB's are not going to be able to just drop their fees back overnight. What happens when the government does stop the gap and a lot of women return to the public system. Still going to be a drain on the public purse I dare say. It is going to be a bit of a mess I expect.

#27 AJ#99

Posted 19 December 2009 - 04:14 PM

Their fees have increased in 7 years... probably about in line with professional indemnity insurance premiums.  Ie, it probably has just as much (if not more) to do with this than just the medicare saftey net.

My OB has let me know that it will be billed in two parts (for ease of cashflow).  Fees have still gone up slightly again, despite the safety net changes!




#28 BentoBaby

Posted 19 December 2009 - 04:28 PM

Out of interest, have any ob's you know of actually changed their fee structure because of this change or dropped their fees? I just can't understand how they will keep patients when in Sydney almost all ob's charge $4500+ at some of the private hospitals in the North. It will go from people being out of pocket $1500-2000 to $4000. That is a lot of money even for families in traditionally "wealthy" areas.

#29 lisafromcamberwell

Posted 19 December 2009 - 08:08 PM

What I have noticed is that obs are no longer willing to discuss fee information over the phone.  So the government's line that patients should 'question their doctors about fees and shop around' has had the opposite effect.  I suspect obs have banded together to defeat what the government has said and done.

#30 Fabulous

Posted 20 December 2009 - 05:40 AM

The medicare safety net was only introduced 5 years ago so I guess things will go back to what they were back there, whatever that was.

#31 jm3

Posted 20 December 2009 - 07:01 AM

QUOTE (ceres @ 20/12/2009, 06:10 AM) <{POST_SNAPBACK}>
The medicare safety net was only introduced 5 years ago so I guess things will go back to what they were back there, whatever that was.


When I had my daughter in 2000 with a private ob, I had 'no gap'... I don't think it will go back to that unfortunately.  I just think it will push more people out of the private sector.


#32 angels11

Posted 21 December 2009 - 08:09 PM

I am facing this dilemma - am currently booked into  both a private hospital and OB and also with a public hospital doing shared care with my GP.  I need to make my decision in the next 4 weeks before I get to 20wks when I have to pay the big bill.  My OB states that he charges $6K-$8K and that I'll end up being out of pocket $5K - if I had my babies (which I m/c) this year I'd only be out of pocket $2.5k.  We were out of pocket nearly $2k with my d&c - I don't really want to pay $5k to leave hospital without another baby.  So part of my decision is about not feeling resentful.

I've spent a good deal of time at both hospitals and actually had an appt with my GP and then my OB the next day and it felt a lot like the same appt.

People are shocked when I tell them I'm considering public - I think because of my m/c - but a private hospital isn't going to save my baby - is it?

#33 Freakin'-out Dad

Posted 03 January 2010 - 11:12 AM

Ingrid

Thank you so much for your post of the other day ('19/12/2009, 12:40 PM'). I personnally found it to be the most comprehensive and informative explanation that I've read on this issue.

We are also expecting in June and I have to say that I simply can't believe that the Government has taken this step with regard to the Medicare cap. WHAT WERE THEY THINKING???? It makes me so mad to think that just at the very time that we are finally feeling as though every cent counts because we want the very best for our child, they come and slug us with this?

I don't need to go into all the ways that new parents are under financial pressure but this added "surprise" just sends me into a cold sweat (an increasingly regular occurrance).

My big question is how on earth did this not register with the media? I'm not being self-centred here. I've always thought that the plight of working families/ new mums/ young families etc have always been a pillar of Australian health related politics and news. Is it because the media just hasn't noticed or is it because the demographic has shifted so much that child-birth issues just don't rate a mention?

As for what we're going to do from here, I just don't know. My beloved has made it very clear that she really wants an Ob that she trusts (and we've found that guy) and i want to be the best husband and Dad that i can be... does anyone know a good remedy for stress related baldness?

Freakin'-out Dad (to be)

#34 =R2=

Posted 03 January 2010 - 02:34 PM

The government had to do something to stop those abusing the system when they found that a staggering amount of the Safety Net actually end up in obstetrician's pockets.

I suggest looking into seeing an independent midwife or going through a hospital team midwifery care system. It's just as good if not better than seeing a private OB.

#35 seepi

Posted 03 January 2010 - 02:45 PM

It has not registered with the media as the govt has been quite clever about their announcements.

- they have left a little refund (200.00) so they can say it is still covered, just 'reduced'.

- they are using the line that women will be 800.00 worse off. This is an average across all of Australia, and bears no relation to the situation in Sydney and Canberra, where women will be more like 2000.00 - 5000.00 worse off.)

- they did not sign this into law until December, so up til then it was 'not definite and no figures could be given'.

- it hasn't happened to anyone yet.

- some people have a perception that only rich people use an OB, so who cares if they have to pay.

  - they are really playing up the line that OBs were just siphoning money out of the safety net. Yet if obstetrics is such a great job then why are the numbers of obstetrician shrinking so rapidly?

I think this will bite them on the bum though when public hospital maternity wings start to burst at the seams (some are already, so how will they cope with an influx of people who would ordinarily have gone private). I think the media will take some notice when women start getting sent away from maternity wings as there is just no more room for them.

#36 Future-self

Posted 03 January 2010 - 02:48 PM

QUOTE (Freakin'-out Dad @ 03/01/2010, 11:12 AM) <{POST_SNAPBACK}>
My big question is how on earth did this not register with the media? I'm not being self-centred here. I've always thought that the plight of working families/ new mums/ young families etc have always been a pillar of Australian health related politics and news. Is it because the media just hasn't noticed or is it because the demographic has shifted so much that child-birth issues just don't rate a mention?


Firstly, no help with the baldness I'm afraid - and medical treatments for it aren't covered on the Safety Net either  wink.gif

The trouble is, couples/young families who are seen to be able to afford PHI and therefore Private Obs etc aren't considered 'Working families' or in need of assistance by our current government. Now, I don't believe in 'middle-class welfare' either, but the swing against dual income couples in everything from this, to the planned ETS subsidy, to the new Government Maternity leave being income tested, to the reduction in PHI rebates to name a few is getting absurd. My DH and I are beginning to wonder how we have got to this point. I agree that Ob fees have grown in crazy amounts in the last four years or so, out of line with insurance premiums etc. But asking the patient to be the one to wear this and somehow influence the fees is just silly. A Cap on the maximum Pregnancy Management fee that could be charged would have been another ( temporary) solution and puts the responsibility back on the Dr.

It could be said that since every other medical specialist is covered under the maximun rebate, this is discrimination against a particular medical condition. And at the end of the day, many [parents are not going to be able to afford it, so will have to opt for public care. And as we all know, thaere's not really room to spare in our Public hospitals!

ETA: words that made more sense!

Edited by futureself, 03 January 2010 - 02:50 PM.


#37 alexdanlucy

Posted 03 January 2010 - 03:01 PM

At least with obstetrics, you can go public and still get decent quality of care.  What about the couples on IVF and those requiring cataract surgery (especially the elderly)?  I'm surprised the media didn't jump all over this.  I know there were some media attention to the cataract surgery, but definitely not enough to make the government reconsider their changes.





#38 MonstersMama

Posted 03 January 2010 - 03:02 PM

QUOTE (futureself @ 03/01/2010, 03:48 PM) <{POST_SNAPBACK}>
It could be said that since every other medical specialist is covered under the maximun rebate, this is discrimination against a particular medical condition.


I might be the thorn in everyones side, but I have to disagree...pregnancy is not a medical condition - its a choice.

#39 alexdanlucy

Posted 03 January 2010 - 03:16 PM

QUOTE
I might be the thorn in everyones side, but I have to disagree...pregnancy is not a medical condition - its a choice.

I agree that to have a baby is a choice.  However, once you're pregnant, it becomes a medical issue (and a legal one).  There are dangers to both the mother and baby and medical intervention and supervision is required.

Edited by fmadr, 03 January 2010 - 03:17 PM.


#40 toni147

Posted 03 January 2010 - 04:00 PM

I don't want a home birth (No judgements, it's just not for me), and I loathe public hospitals with a passion, so the only choice for me is to pay for an OB who will talk to me once a month, take my blood pressure and most likely not show up for the birth. If they'd just allow midwives in Private hospitals to have a medicare provider number it'd solve a large portion of the problem!

Unfortunately a woman can't go to the hospital she wants (and which is covered 100% by expensive private insurance), and have her baby with a midwife she likes and trusts without paying the OB fee to get that access.

Monstamama I agree with you...pregnancy is a choice, and why should single people support our choice to breed? And why on earth should people who had their children during the less expensive days pay for our exhorbitant fees with tax dollars now? Agree completely. I also think we should scrap paying for the ABC, the AIS, public "arts", boob/nose jobs for the military, local Govt salaries, Govt superannuation, most of the public service, treatment of medical conditions related to smoking, alcohol and obesity, IVF, World Cup bids etc. Unfortunately we can't seem to get any politicians to support not paying for any of those things.

It's just that while the Govt is urging people to have babies AND complaining about how overcrowded the public hospital system is, it seems sheer madness to change the system so that additional stress will be placed on an over-stretched system.

PS: Freakinout_Dad, you're not alone. My DH nearly fell over when I told him how much it was going to cost us this time to have a baby. And unfortunately we're PAYG people, so we can't hide our money, use the very broken tax system to our nefarious ends, and claim the baby bonus anyway. He's not balding, but I think he went two shades greyer when I explained it to him. wink.gif

Edited by toni147, 03 January 2010 - 05:04 PM.


#41 natjay

Posted 03 January 2010 - 05:40 PM

just a quick one but when i had DS in december in a public hospital, the birthing unit was full until i was ready to push. scary what will happen if more people use the public system!!

#42 Reneej

Posted 03 January 2010 - 06:03 PM

I was very lucky I hit 20wks before the end of the yr so was able to pay my $1900 fee and still get the max amount back

the government is going to get a huge awaking when the already overcrowded public system will go in Crisis mode

there is no way if I go back for another baby  will I be able to afford to go private and will have to go public



Renee

#43 nurserobin

Posted 03 January 2010 - 07:06 PM

now we just need to save more to cover the costs. the health of me and my baby shouldnt come as a cost like kevin rudd thinks it should. what kind of health care system did mr rudd promise at his election? a better one? what a joke. seems to me he and his people left this one out.





#44 stagedom

Posted 04 January 2010 - 01:35 PM

CURRENT STATE OF PLAY REGARDING OUT OF POCKET EXPENSES WITH A PRIVATE OB

My wife and I had our first OB appointment today (she is 9 weeks at present) and I almost had a cardiac arrest. I knew the rebate structure had changed but I was not prepared for the proposed fee structure. We are probably going to Cabrini or Jesse Mac, and we don't have any choice but to see a private OB given some complications. Here it goes:

1. Initial consultation $250 - out of pocket $181

2. 1st instalment 20 weeks item number 16590 $3,000 - out of pocket $2,739

3. 2nd instalment 31/34 weeks $3,000 - out of pocket $3,000

4. Hospital stay - out of pockets private insurance excess (if any) ours is $500

5. Post Natal Check $160 - out of pocket $125.45

All in all, out-of-pockets will be approx $6,500. Does this seem excessive? Should we be looking for another OB.

I can't really make any comments on how the rebates worked previously but this has become a joke. I cannot put a price on a human life but it seems that OB's and the govt are playing to the heart strings and preciousness of a baby. The basis for the govt changes were to deter OB's from charging excessively, but it is clear that this is not the case here.

Add up all the costs and it pays not to go private. We are not well off but probably can manage paying the $6,500 (as we have some savings that was reserved for purchasing a larger car after 4 years of saving) but without these savings I fail to see how we could afford it, nor could the medium salary earner. It should not come down to couples dipping hugely into their savings to have a baby. Out of pocket expenses of $3,000 would be reasonable, $4,000 maybe justifiable, but $6,000 is just far fetched. When added to the amount of private health insurance we pay each year the costs are almost out of reach. In total this year we will be paying $2,000 in private health insurance and $6,500 in pregnancy related fees. It is a huge chunk of our after tax income. I know we can claim 20% back from the 20% net medical expenses rebate, but $900 is a drop in the ocean in comparison with the total out of pockets.

Does anyone have any advice on options to get into a private hospital without the huge OB fees or should we just clog up the public system.





#45 jm3

Posted 04 January 2010 - 01:40 PM

That is very interesting information stagedom.  I would be interested to see my ob's new charges too.  

You could ring around and get other ob's fees over the phone or go public.  The only options that I see.



#46 Roseberry

Posted 04 January 2010 - 02:49 PM

QUOTE (stagedom @ 04/01/2010, 11:35 AM) <{POST_SNAPBACK}>
All in all, out-of-pockets will be approx $6,500. Does this seem excessive? Should we be looking for another OB.

Eeek, that does seem hefty.

I'd probably have a look around for another OB and see what their charges are.

Our out of pocket expense for private care will be $2140.00

#47 Alis Volat Propiis

Posted 04 January 2010 - 02:55 PM

This may come accross as naive but can you not just see your OB and pay for each consultation as an individual appointment? What i mean is that i see an OBGyn for issues related to my first pg with DD, but am not seeing her as an OB for this pregnancy. I pay her $150 per appointment and as we are self funded get some of this back from medicare. I know it doesnt work that way, but surely if you were to see your OB every month up to 36 weeks and weekly till term you would still be ahead in regards to pregnancy management fees. What on earth does your money pay for?

The other choice is to go public as PP's have said. A high risk pregnancy is still OB managed in the public system. You would get a similar number of OB appts and scans however do have to accept that some of the appts may be with an OB registrar and not the consultant directly.

Sharna

#48 QueenElsa

Posted 04 January 2010 - 03:18 PM

Stagedom- if you ring around you can probably get it down by 1 or 2k - my out of pockets were the same as yours except the 1st installment was $1500 (at FPH in Parkville).  And then there's the ultrasounds and blood tests...not much back from that.


The public system can look after women with complications.
Good luck!

#49 seepi

Posted 04 January 2010 - 03:40 PM

STagedom - you need to know the medicare item numbers for those fees. thr first fee of 3000.00 is the same as my Pregnancy and Management Fee. this is a fee for manageing a pregnancy beyond 20 weeks to birth. (This is the one that used to get 80% back under safety net, and now gets only 200.00).

But the second 3000.00 - I'm not sure if your OB is actually charging 6000.00 for the Pregnancy and mngt fee, and letting you pay in two installments, (in which case the whole lot is basically out of pocket), OR if the second fee is the delivery fee. if it is the delivery fee you may find you get most/all of it back from your private health insurance.
00
In my case my OB has a no gap delivery fee, so I don't see that fee - he just bills the Private health, but I know it is around 3000.

In addition to your schedule of fees I also pay for each appointment (80.00) and also for 3 scans, which are around 200 ish. Nothing back from medicare on the 12 week scan either, which I found bizarre - in my late 30s I wouldn't have classed this scan as 'optional'.

I hope you will find that your second large fee is the delivery fee and your health insurance will pay. If not, and your OB is charing 6 thousand management fee, you may find a cheaper one. I know OBs in Sydney are expensive, but i would still ring around. the two big fees are Pregnancy Mangement, and Delivery - I wouldn't bother asking about any other fees. Ring around quickly though. Most OBs book out quickly, I imagine any cheap ones book out even quicker.

#50 BentoBaby

Posted 04 January 2010 - 04:01 PM

$6500 is VERY expensive for an ob. Even the ob's at North Shore Private/Mater (think expensive) only average around $4500. I think you could definately find a less expensive ob.

The changes really do suck. I am also surprised that no nightly news/today tonight etc have made a big deal of it. It is going to have a huge impact in places like Sydney.




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