Congratulations on your pregnancy! Having a baby is a very special time for you. It is one of the most important occasions in your life.
One of the first questions a couple ask is how much will it cost to have their baby?
When you choose to go private for your care there will be ‘out of pocket’ expenses which will vary and which can be confusing to understand. This article is to give you more insight into possible expenses you may incur in having your baby.
The information below is not relevant if you elect to be in HCF and be confined at the Sydney Adventist Hospital (the San) through their Swaddle program.
If you are in the Swaddle program there will be no gaps for you to pay for usual pregnancy care. There will be no gaps payments to me, to the anaesthetist (if needed), to the paediatrician, on pathology (through Douglass Hanly Moir Pathology) (except NIPT) or on ultrasound scans at Ultrasound Care (San Ultrasound for Women).
These will vary from one obstetrician to another. As well, the billing methods will also vary between obstetricians. That is because private obstetricians are self-employed. I will confine my comments to what we do. Please do not assume our fees and what we do with billing is the same as other obstetricians’ fees and what other obstetricians do with billing. If you are ‘shopping around’ you will have to contact the secretaries of other obstetricians to find out their fees are and how they bill their patients.
I have tried to keep our billing system simple and our services affordable. By keeping our billing system simple it is easier for you to understand our fees, and for you to financially plan and to budget for your pregnancy care. As well, it is much more convenient and much more efficient for you and for my staff. I am conscious that money is tight for many people and so I have tried to keep the ‘out of pocket’ expense for obstetrician fees of pregnancy care to a level that we believe is affordable for most patients and yet is viable so there is enough medical practice income to pay the considerable medical practice overheads.
It is very important for you to understand when you book with me (Dr Gary Sykes) for your pregnancy care the amount you are ‘out of pocket’ for your pregnancy care obstetrician fee will not change, irrespective of how complicated your pregnancy is, your delivery is, or your postnatal period is or how many antenatal or postnatal visits you need.
You will only have gap payments to make for your first antenatal visit fee and for your pregnancy management fee.
You will be ‘bulk-billed’ for all subsequent antenatal visits and for your postnatal visit. This means there will now be no ‘out of pocket’ payments for subsequent antenatal visits. As well, there is no payment for all 2D/3D ultrasound scanning of your baby each visit, your delivery (including if needed an operative vaginal delivery or a Caesarean section delivery and for twins), your in-hospital postnatal care, my management of any postnatal complications, your six-weeks postnatal visit and any other outpatient postnatal visits that may be needed. This is on the condition you are Medicare and appropriate health fund cover. As well, we will give you a gift of a USB to store your baby ultrasound photos.
Please phone our office on 02 9680 3004 for more information on our fees. Fees will be discussed in detail at your first antenatal visit and at a ‘meet and greet’ appointment.
Out of hospital bills
You are entitled to a Medicare rebate for all invoices for medical services that are provided outside of hospital as long as the service has a Medicare item number and you have Medicare entitlement. Most health funds will not reimburse you to any extent for any medical services when they are provided to you without you being a hospital in-patient at the time.
I will do an ultrasound scan of your baby at each antenatal visit. These give me greater accuracy in assessing your baby’s position, growth, and wellbeing and more. As well, patients enjoy seeing their baby’s images (especially 3D and 4D), growth, movement, etc. We give you a USB at your first antenatal visit to store your baby photo images. There will be no billing for any ultrasound scans done by me.
I will refer you to a specialised pregnancy ultrasound unit for the foetal morphology scan (at 19 weeks) and if you wish a nuchal translucency scan (at 12 weeks). There may be on occasions the need for you to have other ultrasound scans done by a specialised pregnancy ultrasound unit because of adverse pregnancy developments. There will be gap payments for these external referred ultrasound scans.
You can choose to have these external scans done by a radiology practice, which will bulk-bill you. The trade-off may be accuracy. A general radiology practice is staffed by doctors whose background training is as radiologists (x-ray doctors). In contrast, a specialised pregnancy ultrasound unit doctors’ background training is as obstetricians. The specialised pregnancy ultrasound unit doctors’ business focus is only women’s obstetrics and gynaecology ultrasound scans. Doctors working in a specialised pregnancy ultrasound unit have done extra training in pregnancy ultrasound scanning and are certified as subspecialists in obstetric ultrasound scanning. This is not so of radiologists working in a radiology practice. The general radiologist practice provides lots of services (ultrasound of all parts of the body, x-rays, CT scans, MRI scans, etc.) and has no special interest in pregnancy ultrasound scanning.
Occasionally a patient needs a radiology assessment in pregnancy. I will endeavour to have this bulk-billed so there will be no out of pocket cost to you.
I use Douglass Hanly Moir Pathology. They are the largest pathology company in NSW and they have a strong focus on accuracy and quality control. As well I can easily access your results online. There will no gap payments for your routine pregnancy pathology tests arranged by me except NIPT screening. There is no Medicare rebate for NIPT screening and hence there is an ‘out of pocket’ charge.
Sometimes I need to refer a patient to another specialist during the pregnancy because of other health considerations (such as diabetes in pregnancy). The specialist who is seen is also a self-employed doctor and will bill you directly. How much other doctors charge will vary. Consequently, how much you will be out of pocket after you are reimbursed by Medicare for their bill will vary. Usually, the gap is reasonable so do not be too concerned.
You are entitled to Medicare rebates and health fund rebates for doctors’ invoices for medical services provided to you when you are a hospital inpatient as long as you have Medicare entitlement and have an appropriate level of health fund cover.
If you have maternity cover with your health fund then the only amount you will need to pay the hospital for your admission is ‘the excess’ of your policy, if you have nominated an excess. Your health fund will pay the hospital all the rest of their invoice.
If you do not have maternity cover with your health fund or if you are not in a health fund, then you need to pay the total hospital bill. The hospital will want this payment before you will be accepted for delivery. Your invoice will be in keeping with what the hospital would be paid but a health fund. You may end up with a refund if your stay is less than the usual duration. You will need to contact the hospital directly for more information. Also see the article How much will it cost if I am not in a health fund?
In-hospital pathology, ultrasound, and radiology
It is usual that you will need pathology services while in hospital. These are provided by the pathology company used by the hospital. Your billing will not be by the hospital but from this pathology company. The hospital stay costs does not include pathology tests. If I have completed the pathology test form I will indicate there is to be no gap payment. But if the pathology request has been submitted by someone else then there may be a gap payment.
Sometimes a patient will need an ultrasound and radiology studies while in hospital. These services are provided by the radiology or ultrasound company used by the hospital. Your billing will not be by the hospital but from this radiology or ultrasound company. There is usually a gap to pay for their services. How much you will be out of pocket after you are reimbursed by Medicare and your health fund for their bill will vary depending you the service provided and their fees. Usually the gap is reasonable so do not be too concerned.
If you have an epidural in labour or a Caesarean section delivery you will need the services of an anaesthetist. Private hospital anaesthetists are self-employed doctors. The hospital does not pay them for their services and so they will bill you directly.
There is usually an ‘out of pocket’ expense for anaesthetic services. How much anaesthetists charge varies. How much you will be ‘out of pocket’ after you are reimbursed by Medicare and your health fund for their bill will vary. If you are having an elective Caesarean section my secretary can advise you (close to your operation date) the details of the anaesthetist I will be using and you can contact the anaesthetist or their staff directly to find out how much your anaesthetic fee is likely to be. The anaesthetist bill can vary depending on how long your operation takes.
If you have an epidural in labour or an emergency Caesarean section then the midwife will contact the anaesthetist on call to attend. How much you are ‘out of pocket’ is impossible to determine prior as you (and I) do not know which anaesthetist will attend. Usually the gap is reasonable so do not be too concerned.
If you have an emergency Caesarean section after being in labour you may have two anaesthetists involved in your care and so two anaesthetic billings – one anaesthetist for an epidural in labour (if relevant) and the other to give you anaesthetic support during your Caesarean section operation.
Your baby will be under the care of a paediatrician. Unless you nominate one of the hospital paediatricians, the paediatrician who looks after your baby will be the one who is rostered on the day you deliver. Paediatricians in private hospitals are self-employed doctors. The hospital does not pay them for their services and so you will be billed directly. How much paediatricians charge varies. How much you will be ‘out of pocket,’ after you are reimbursed by Medicare and your health fund, for their bill will vary. Usually the gap is reasonable so do not be too concerned.
If you have an elective Caesarean section at Norwest Private Hospital or the Sydney Adventist Hospital or an emergency Caesarean section at the Sydney Adventist Hospital Hospital there will be a doctor assisting me with the operation (called a surgical assistant). Surgical assistants are self-employed doctors and so you will be billed directly. How much surgical assistants charge varies. The surgical assistant bill can vary depending on the surgery you have done. How much you will be ‘out of pocket’ after you are reimbursed by Medicare and your health fund for their bill will vary. Usually the gap is reasonable so do not be too concerned. I have two regular surgical assistants. If you want to check out their likely fee please contact my secretary close to your operation date to get the surgical assistant’s contact details.
There may be extra invoicing not covered above because of your personal health circumstances and also because of complications in your pregnancy, with your labour and childbirth or in your postnatal period. Management of these complications will result in extra costs. It is endeavoured to keep extra unforeseen costs to a reasonable level, so do not be too concerned. The trade-off is you can have reassurance that because you are a private patient in a private hospital if something adverse does happen your and your baby’s primary health care providers will be specialists, experts in their medical fields, and not trainees.
Very occasionally a patient will change to public because of the out of pocket costs in being a private patient. As a public patient, there will be no ‘out of pocket’ costs to pay. But there is huge trade-off. There are considerable differences between private and public healthcare for pregnancy management. These differences are summarised in the article “Private vs. Public Care for my Pregnancy” on this website.
Also check out
on this website:
- Give us a call on 02 9680 3004.
- Why not book a “Meet and Greet” appointment? The purpose of a “Meet and Greet” appointment is so you can meet us without you needing a referral from your doctor and without you being charged a consultation fee. We can discuss with you fees and billing in detail. As well, you can get to know us and we can get to know you and your pregnancy expectations.