How much will it cost if I am not in a health fund?

From time to time we have patients and enquiries from prospective patients who for one reason or another are not covered by a health fund.

Below is guide as to what you can expect and where possible bills will come from. It is impossible to do an exact calculation of the cost you will be in for as it will vary because of unpredictable developments in pregnancy and childbirth and because fees for the same service will vary from one doctor to another. OE cartoon characters worried 2

Dr Sykes’s fee

Whether or not your are in a health fund is irrelevant  for your ‘out-of-hospital’ pregnancy care, as long as you have Medicare cover. That is because health funds only contribute to ‘in-hospital’ care costs.

We are a ‘no gap’ practice for health funds which means we send our invoices for delivery and inpatient care directly to the relevant health fund for remuneration without there being any gap for the patient to pay. But as you are not in a health fund you will need to pay in full the delivery fee by 35 weeks pregnancy. You can claim a portion of the payment from Medicare. Please ask my secretary for more information.

Hospital fee

As you are not in a health fund you will have to pay the total hospital bill. You will need to contact Norwest Private Hospital or the Sydney Adventist Hospital directly to find out more information. As well the hospital will require you to may their likely fee in full before it will be agreed for you to deliver there.

If you have a reduced duration postnatal stay in the hospital your hospital fee will be less. You are required to stay a minimum of 24hrs after birth. The hospital will bill you as for a full stay and then give you a part refund

If there are complications of pregnancy that necessitate you being admitted before delivery or need admission to intensive care, etc. your hospital fee will be more.

If your baby needs to be admitted to the Special Care Nursery for six hours or more there will be an extra fee.

Other doctors’ fees

As well as Dr Sykes’ fee and the hospital fee you will be invoiced separately by other doctors who are involved in your care or the care of your baby. This will include a paediatrician, possibly an anaesthetist (if you have an epidural in labour or Caesarean section) and possibly a surgical assistant (if you have an elective Caesarean section).

If you have a very complicated pregnancy, delivery or postnatal period other doctors may need to be involved in your care, who will invoice you directly. There can be part reimbursement of doctors bills through Medicare. If your had been in health fund with an appropriate level of cover, the health fund would also contribute part reimbursement for medical services while you are an inpatient.

Health fund waiting period

Some health funds will still cover baby as long as you join a minimum of two months before your delivery and have baby on your cover.

Each health insurance company has varying policies with your cover for pregnancy so you would need to call them to find out their specific requirements. We consider the cheapest option  is single parent cover and be ready to add your baby to your policy.

A list of health funds is on the Australian Government Private Health Fund website. You can also compare fund on this official government website

See also the website article How much will it Cost? for more information on billing and possible out of pocket expenses.

Posted by Dr Gary Sykes on -

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