Having a baby in Australia
Apr 22nd 2012, 11:00 am
#31
BE Forum Addict
Joined: Feb 2010
Location: Amongst Melbourne's tall gum trees
Posts: 1,323
Re: Having a baby in Australia
Oh ok, I see where you're getting confused. Private hospital insurance covers procedures in hospitals only. It has nothing to do with private medical specialists or private GP costs.
Each procedure in a private hospital has a govt mandated scheduled fee. The private hospital specialists (eg OB/anaesthetist) are free to charge more than this fee. As I understand it the bill is met roughly as follows:
1) 75% of scheduled fee paid by govt medicare.
2) 25% of scheduled fee paid by your private hospital insurance.
3) anything above the scheduled fee paid by you (The Gap).
You can ask your specialist to treat you in hospital as a No Gap patient. ie you will be charged the scheduled fee only so you will then pay nothing at point (3) as govt medicare (1) and private hospital insurance (2) will cover the whole bill. (Note: An anaesthetist for example can charge more than the scheduled fee whether a nightime callout or not)
Outside of a hospital, private specialist and private GP bills are met by a combination of govt medicare and yourself. A few things are not govt medicare billable at all so you will bear full cost. I will emphasise that private hospital insurance is not involved at all.
If you wish to avoid paying the gap charged by some private GP's you must find a bulk billing private GP or visit a public hospital and if you want to avoid paying the gap seeing a private specialist you must either find a private specialist who bulk bills (rare) or visit a free public specialist at a public hospital outpatients clinic similar to the NHS.
Each procedure in a private hospital has a govt mandated scheduled fee. The private hospital specialists (eg OB/anaesthetist) are free to charge more than this fee. As I understand it the bill is met roughly as follows:
1) 75% of scheduled fee paid by govt medicare.
2) 25% of scheduled fee paid by your private hospital insurance.
3) anything above the scheduled fee paid by you (The Gap).
You can ask your specialist to treat you in hospital as a No Gap patient. ie you will be charged the scheduled fee only so you will then pay nothing at point (3) as govt medicare (1) and private hospital insurance (2) will cover the whole bill. (Note: An anaesthetist for example can charge more than the scheduled fee whether a nightime callout or not)
Outside of a hospital, private specialist and private GP bills are met by a combination of govt medicare and yourself. A few things are not govt medicare billable at all so you will bear full cost. I will emphasise that private hospital insurance is not involved at all.
If you wish to avoid paying the gap charged by some private GP's you must find a bulk billing private GP or visit a public hospital and if you want to avoid paying the gap seeing a private specialist you must either find a private specialist who bulk bills (rare) or visit a free public specialist at a public hospital outpatients clinic similar to the NHS.
Will any specialist accept to treat you in hospital as a No Gap patient? And is that for both private and public hospitals? Or do you have to be in a private hospital with a private specialist to get the No Gap option? 
That is still a bit fuzzy in my slightly tired brain.At least I now understand that what I saw as private health insurance is really just private hospital insurance (hence why they call it that on my policy
Duh me!
) and then they con you with the extras that really only cover bits that you can live without, except maybe dental cover 
Apr 22nd 2012, 2:51 pm
#33
Lost in BE Cyberspace
Joined: Dec 2008
Posts: 6,039
Re: Having a baby in Australia
If you attend a private specialist you sometimes have the option of using a public hospital as a private patient. So hospital accommodation will be free and your private insurance will cover the doctors fees, or part thereof.
Some people do this who have no private hospital insurance as it allows them to jump the queue for elective surgery and still keep the costs down below years of insurance premiums. I have heard that specialists reduce their fees when they hear their private patient in a public hospital has no insurance. It would increase your chances of being a No Gap patient.
At least I now understand that what I saw as private health insurance is really just private hospital insurance (hence why they call it that on my policy Duh me!) and then they con you with the extras that really only cover bits that you can live without, except maybe dental cover
Duh me!) and then they con you with the extras that really only cover bits that you can live without, except maybe dental cover This page is excellent reading: http://www.privatehealth.gov.au/heal...ed/default.htm
Last edited by fish.01; Apr 22nd 2012 at 2:54 pm.
Apr 23rd 2012, 2:23 am
#34
Joined: Oct 2009
Posts: 162
Re: Having a baby in Australia
WHOOP WHOOP WHOOP......
just called and YES !!!
all covered!!!!
yippeeeeeeeeee
just called and YES !!!
all covered!!!!
yippeeeeeeeeee
Apr 25th 2012, 11:11 am
#35
Forum Regular
Joined: Mar 2008
Posts: 144
Re: Having a baby in Australia
Just interested (I'm not pregnant) when considering Public vs Private - if you want an elective c-section can you get this with Public or do you have to go Private?
Just heard rumours that the UK was going down the line of giving women the choice on the NHS, wondered if Oz was similar?
Just heard rumours that the UK was going down the line of giving women the choice on the NHS, wondered if Oz was similar?
Apr 26th 2012, 1:39 am
#36
Forum Regular
Joined: Dec 2008
Location: Perth, Australia
Posts: 133
Re: Having a baby in Australia
No unless you have had a previous c-section it is going to be difficult to get an elective on the public system. I have heard of women claiming to need electives due to strong fear of childbirth etc but not always successfully. I was not going to put myself and the baby through the emotional trauma of having to fight for an elective while pregnant so I chose to go private. Even going private my obstetrician really wanted me to go natural despite my strong desire to have an elective. Eventually a medical condition meant that I did have a last minute elective. It was so wonderful, calm ,peaceful and joyous and I have the most wonderful memories of the birth of my daughter. Very different to the NHS natural birth of my son 2 years earlier: 54 hours of labour, excruciating pain, delerium and vomiting from the gas and air, I could go on to be more graphic and gross but you get the picture. I love my boy but but his birth was a nightmare. I am so happy for people that have regular doable natural births but I am not one of them. I am a huge believer in a mothers choice!!
Apr 26th 2012, 2:04 am
#37
Forum Regular
Joined: Mar 2008
Posts: 144
Re: Having a baby in Australia
It totally depends on the obstetrician. Some will happily give you a c-section and others won't. Mine always said that ultimately it was my choice but he spent a lot of time convincing me that I could have a vaginal birth without all the trauma of my first birthing. He actually had me convinced and I was willing to give it a go but then we had to have a csection anyway. He was all apologetic about it afterwards and kept checking that I was OK with what had happened. Can't believe the huge grin on my face was not enough to convince him that I loved my birthing experience!!
