We’re fortunate to have a high-class public health system in Australia. But for various reasons many women decide to give birth in a private hospital. Some women prefer being able to choose their own obstetrician for the entire pregnancy to birth, want their own private room in hospital or want to give birth in a particular hospital.
Most women are aware of the 12 month waiting period for pregnancy or childbirth, but are shocked by the out-of-pocket expenses that aren’t covered by private health insurance. Out-of-pocket expenses can all add up to between $5,000 – $20,000 which is significant when you also consider the thousands of dollars you’ve spent on monthly insurance premiums.
Below are 9 types of out-of-pocket expenses that aren’t covered by private health insurance, and most are costs incurred out of hospital before you give birth. These costs are based on my experience with a low-risk, single pregnancy with my private obstetrician.
Since I pay about $170 per month for Gold Hospital Cover which includes pregnancy and childbirth, I was disappointed that there weren’t more pregnancy-related fees that could be reimbursed by private health insurance.
Be sure to discuss all costs with your obstetrician, private health insurer and private hospital so you fully understand all costs before you commit.
1. Antenatal visits with obstetrician
Obstetricians are private specialists who set their own fees. Obstetricians that are based in metropolitan areas or who are more experienced usually charge higher fees. Legally, they need to provide you with a summary of all their fees, called an ‘informed financial consent’. Try ringing round to compare costs before you book your first consultation.
Keep in mind that usually antenatal visits are monthly in the first and second trimesters (until 28 weeks) and then become fortnightly or weekly as you approach your due date, depending on your pregnancy risk and any complications. So during your entire pregnancy you’ll have a total of 10-12 antenatal visits for a low-risk pregnancy.
Your first antenatal visit (or initial consultation) fee will usually be higher, and follow up appointments will cost less.
Part of the antenatal visit fees can also be claimed back from Medicare, about $35-$75 depending on stage of your pregnancy.
2. Pregnancy management fee for obstetrician
This is a one-off fee and is expensive, usually between $3,500 – $5,000. This fee is mainly to cover the obstetrician’s professional indemnity insurance. The cost and when it needs to be paid will be on the ‘informed financial consent’.
Part of the pregnancy management fee can also be claimed back from Medicare, about $400-$700.
3. Labour/Delivery management fee for obstetrician
This will usually be claimed by your obstetrician from your private health insurer. You will just need to pay your excess or ‘gap fee’, usually $500.
4. Genetic testing
Genetic screening (blood) tests for Down Syndrome and other chromosomal abnormalities are offered in the first trimester. It can cost between $400 – $800 depending on where you get the test and whether you also have other tests such as an ultrasound too.
There is no rebate under Medicare.
You may be offered different scans throughout your pregnancy and these are usually performed at a private imaging or ultrasound provider. Each scan can cost between $150 – $400.
Part of ultrasound costs can be claimed back from Medicare, about $50 – $85 depending on the type of scan. From 1 July 2020, Medicare rebates for ultrasounds will be increased which should reduce out-of-pocket expenses.
6. Surgical assistant
If you’re having a caesarean delivery (c-section), your obstetrician will need a surgical assistant which usually costs about $500. The surgical assistant will bill you directly afterwards.
Part of the surgical assistant’s fee can be claimed back from Medicare, but I’m not sure of the exact amount.
7. Anaesthetist fees
Pain relief, such as an epidural, may be used for women in labour or who are having a caesarean (c-section) which will require monitoring from an anaesthetist (specialist). Anaesthetists set their own fees as they are private specialists and can cost between $500 – $1,500. The anaesthetist will bill you directly afterwards.
Part of the anaesthetist’s fee can be claimed back from Medicare, but I’m not sure of the exact amount.
8. Paediatrician fees
If your newborn is healthy then they will not be admitted to the hospital as a patient so any check-ups from a paediatrician (specialist) will not be covered by your policy. You will not be discharged from hospital until your newborn has been cleared by a paediatrician so this fee is unavoidable. Paediatricians set their own fees which is usually from $300 depending on the specialist, number of check-ups and any treatments/tests for your newborn. The paediatrician will bill you directly afterwards.
Part of the paediatrician’s fee can be claimed back from Medicare, but I’m not sure of the exact amount.
9. Postnatal visit with obstetrician
Your obstetrician usually schedules a postnatal visit about 6 weeks after you give birth to check on your health and wellbeing, and how your body is recovering after childbirth.
Part of the postnatal visit fee can also be claimed back from Medicare, about $40.