Obstetric Fees
The fees charged for a delivery are based on the Australian Medical Association (AMA) charges. Your Health Insurance Fund does not pay the AMA recommended fee and thus there is an "Out of Pocket" (OOP) amount that you pay during the pregnancy. The Extended Medicare Safety Net will reduce some of the Out of Pocket costs.
You will billed for each visit you have. Consultations as an outpatient (where you are not admitted to a hospital) will receive a Medicare rebate. Your Private Health Insurance (PHI) only covers care whilst you are admitted to a hospital or day surgery facility. You may at times be seen as an outpatient at a hospital and thus would not be eligible for PHI rebate at that consultation.
You will be billed for each outpatient visit until you have paid the Antenatal Planning Fee at 28 weeks. Some patients may need more or fewer visits depending on their circumstances, but once the Antenatal Planning Fee is paid, all further visits are Bulk Billed through Medicare.
What does this typically look like up until you have your baby:
Fees correct as at 01 August 2022. Other fees available on request (E&OE).
You have probably chosen your PHI based upon both the features and the costs. Possibly you have used an online brokerage such as iSelect. We currently deal with over 70 of these PHI funds and they all have different rules and coverage. Typically, we use one of two item numbers for billing a delivery - 16519 and 16522. This will depend on Medicare determined complications and conditions present during the pregnancy. Depending on your PHI fund and level of cover, I will directly bill your PHI fund and you should have no out of pocket expense from me.
Some funds pay as little as $801.20 for Item 16519, whilst others pay up to $2363.10 for Item 16522. On average the middle of the road funds pay $1700.00 and $2300.00 respectively, and thus I base my fees around these numbers.
Let me illustrate this with the most common billing scenarios for a delivery:
Full Private Insurance with most PHI funds (No Gap / Direct Billing):
Item 16519 - Your bill will be sent to the PHI fund and I would be paid directly by them. You would have no OOP cost for the delivery from me.
Item 16522 - Your bill will be sent to the PHI fund and I would be paid directly by them. You would have no OOP cost for the delivery from me.
Full Private Insurance with a specified fund (You are expected to cover any gap):
Item 16519 - Your bill will be sent to the PHI fund and I would be paid directly by them. You will be billed for the remainder, based on a total fee of $1700.00. You will be approximately $800.00 OOP because of my fees.
Item 16522 - Your bill will be sent to the PHI fund and I would be paid directly by them. You will be billed for the remainder, based on a total fee of $2300.00. You will be approximately $800.00 OOP because of my fees.
Self Funded, No PHI (You are billed):
Item 16519 - You will receive a bill for $1700.00. You pay this to me and then submit this to Medicare and they will reimburse you around $500.00. You will be approximately $1200.00 OOP because of my fees.
Item 16522 - You will receive a bill for $2300.00. You pay this to me and then submit this to Medicare and they will reimburse you around $1200.00. You will be approximately $1100.00 OOP because of my fees.
Please remember that my fees relate only to those I charge you or your PHI fund. Many others are involved in your care and you should expect bills from the following providers:
• Pathology
• Ultrasound
• Anaesthetist
• Paediatrician
• Surgical assistant
• PHI Fund Hospital Excess
Please feel free to discuss these charges with us.
