The Costs of having a baby
The costs of having a baby
Introduction
Intro
Having a baby is an exciting time. No doubt most new parents will be faced with many questions, one of them being ‘what does it really cost to have a baby?’ Well, depending on which way you choose to go, health system costs can vary, so it’s worth understanding what you might be up for. This is an example of the costs you might expect if you use your private health insurance during pregnancy, as a private patient in a private hospital.
This guide assumes that you have a level of cover that includes obstetrics. It’s important to know that obstetrics is not covered on every health cover and a 12 month waiting period applies if you are a new customer or have just moved to a cover that includes obstetrics. On some nib health covers a benefit limitation period may also apply to new customers (this means you’ll receive only restricted benefits after your 12 month waiting period and up to a period of 24 months). So if you’re planning a baby, and you’d like to use your health insurance to go to a private hospital, you’ll need to be on a health cover that includes obstetrics at least 3 months before you start trying to fall pregnant. We recommend that you call nib on 13 14 63 to ensure you have an appropriate level of cover.
One thing most people don’t know is that in Australia, health insurance can only cover you for in-hospital services.
This means, most medical expenses during pregnancy will not be covered by your nib health cover until you arrive in the hospital to have your baby (but they may be covered, at least in part, by Medicare). Health insurance cannot cover you for outpatient services such as GP and Obstetrician visits, scans or blood tests.
The GP and specialist costs in this guide are an approximate average range of costs in Australia. These costs vary greatly depending on your choice of specialist, and where you live (GP’s and specialists in metro areas typically charge higher fees). The in-hospital Obstetrics costs, health insurance benefits paid and out-of-pocket amounts are based on an approximate average of nib customer claims data for an uncomplicated pregnancy and industry averages for the year 2010.
There’s also some information, and a few tips that may help you avoid some out-of-pocket costs during your pregnancy. For more information we suggest you give nib a call on 13 14 63 to discuss your options.
The information contained in this study is of a general nature only. It is not based on your personal circumstances and needs. You should consider whether the information in this study is appropriate having regard to your circumstances and needs. To obtain advice or more information about any of these topics you should speak to a GP, obstetrician or maternal health professional. All costs were correct as at November 2011 and change annually.
Week 1-4
1-4
So you think you might be pregnant? The first thing to do is visit your GP who is likely to conduct a urine test to confirm your pregnancy and screen for a urinary tract infection. Pregnancy and urinary tract infections often go hand in hand as pregnancy hormones put women at an increased risk to develop UTIs. At this appointment your GP may also provide you with a referral for your first routine blood test, which can be done any time, but is best done as early as possible in your pregnancy.
You will need ongoing care throughout your pregnancy, and your GP may be able to provide a referral to an Obstetrician (OB) of your choice. Ask your GP to supply a list of Obstetricians in your area.
Once you have created a shortlist of Obstetricians, we recommend that you give some or all of them a call and ask the following questions:
- At which hospitals do they deliver?
- Is that a public or a private hospital?
- Can they provide a rough guide to their fees and charges for the planning and management of your pregnancy?
- Do they participate in nib’s MediGap scheme?
We also recommend asking if they are taking any more patients, and what l arrangements your Obstetrician has if he / she is away at the time of your delivery.
| Costs | Medicare Schedule Fee | Doctor or Specialist Cost | Medicare Rebate | PHI Benefit | Out of Pocket |
| GP Consultation | time based. Up to $80.75 | $35.60 - $150 | time based. $35.60 for 15 minute consultation | $0 | $0 - $69.25 |
Week 5
5
Once you have narrowed down your shortlist of Obstetricians to one or two, give us a call on 13 14 63 to find out:
- if the hospitals the OB works in are under contract with nib. You are likely to have more out-of-pocket expenses if your OB of choice performs at a hospital not under contract with your fund.
- Confirm whether they have participated in nib’s medical gap scheme in the past.
Once you've decided on your OB, and checked the relevant details (from Week 4) with us, you can give the Obstetrician a call and ask to be booked in as a patient.
Your first OB appointment is likely to be 10-12 weeks into your pregnancy. You will make a schedule of appointments approx once a month until you are 32 weeks along and then around every fortnight until you give birth.
Week 6
6
Around this time, you may be due for your first routine blood test to check that you and your baby are healthy. This blood test will vary depending on your age and risk profile, but will usually test for things such as blood group and antibodies, rubella and hepatitis B & C. Other things that you might be tested for include Syphylis (which is mandatory in most states), haemoglobin, HIV (mandatory at many hospitals) and Varicella Zoster (‘chicken pox’). If necessary, you may need another appointment with your GP to discuss your results.
| Costs | Medicare Schedule Fee | Doctor or Specialist Cost | Medicare Rebate | PHI Benefit | Out of Pocket |
| GP Consultation | time based. Up to $80.75 | $35.60 - $150 | time based. $35.60 for 15 minute consultation | $0 | $0 - $69.25 |
| Blood Screening | $34.70 - $69.55* | $29.50 - $200 | $29.50-$59.15 | $0 | $0 - $140.85 |
| *Medicare Fee is approx. average cost which varies depending on what is being tested |
Week 10
10
In or around week 10 you may be due for the first consultation with your OB. At this appointment they should supply you with a schedule of ongoing fees and charges that you can expect to pay as part of their management of your pregnancy.
This may include costs for:
- ongoing consultation fees
- ultrasounds
- blood test/screenings
- planning and management fee
- delivery fee
Your health insurance only covers you for the cost of the delivery fee in hospital; the other costs may, however, be covered in part by Medicare.
We recommend you ask for informed financial consent from your OB. This just means that you both agree on the set charges for services throughout your pregnancy, so you know what you will be paying in advance. Be sure to also check with them:
- what happens regarding their fees if you experience complications during your delivery
- what happens if you require an anaesthetist and how you can understand their costs upfront
- what happens if your baby experiences complications and needs to be admitted to hospital
| Costs | Medicare Schedule Fee | Doctor or Specialist Cost | Medicare Rebate | PHI Benefit | Out of Pocket |
| First OB Consultation | $83.95 | $150 - $300 | 85% ($71.40) | $0 | $79 - $229 |
Week 11
11
Around this time you may be due to have your First Trimester Screening. This is entirely optional, and will involve a blood test and ultrasound to test for your baby’s risk of Down Syndrome, other abnormalities such as Spina Bifida and to detect multiple pregnancies. If you elect to have this test you may have received a referral from your OB at your initial consultation for this screening.
| Costs | Medicare Schedule Fee | Doctor or Specialist Cost | Medicare Rebate | PHI Benefit | Out of Pocket |
| Blood Screening | $34.70 - $69.55* | $29.50 - $200 | $29.50 - $59.15 | $0 | $0 - $141 |
| Ultrasound | $150 | $150 -$300 | 85% ($127.50) | $0 | $22.50-$172.50 |
| *Medicare Fee is approx. average cost which varies depending on what is being tested |
Week 12
12
If the results of your First Trimester Screening show an 'at increased risk' of Down Syndrome or other chromosome abnormality, a diagnostic test and/or genetic counselling may be recommended. The tests may be conducted as follows.
| Costs | Medicare Schedule Fee | Doctor or Specialist Cost | Medicare Rebate | PHI Benefit | Out of Pocket |
| Chorionic Villus Sampling (CVS)(through the abdomen or cervix) | $119.60 | $550 - $1000 | 85% ($101.70) | $0 | $448.30 - $898.30^ |
| Amniocentesis (through the abdomen) this may be conducted at Week 14 or 15 | $62.30 | $550-$1000 | 85% ($53.00) | $0 | $497 - $947^ |
| ^Unless your First Trimester Screening indicated that you have an ‘increased risk’ of Down Syndrome or other chromosomal abnormalities you will not be required to pay for these tests |
| Note: The cost of genetic tests such as CVS and Amniocentesis depends on whether it is conducted in a public or private facility. Karyotyping and Flouresecent in Situ Hybridization (FISH) are specific types of diagnostic or results analysis conducted by a laboratory. This type of analysis carries an additional charge to standard test analysis, and has a Medicare rebate of $319.15 if elected. The FISH procedure has no Medicare rebate and the cost varies considerably — from $50 to about $400 at different laboratories. We recommend you discuss these options with your OB. |
Week 15
15
You may be due to have your Second Trimester Screening. This is entirely optional and can be available to women who are too late for the First Trimester Screening test, or if the First Trimester Screening test is not available in their area. This is usually a blood test that provides information on your baby’s risk of developing Down Syndrome or Spina Bifida. This maybe called a Maternal Serum Screen (MSS) or Triple Test.
| Costs | Medicare Schedule Fee | Doctor or Specialist Cost | Medicare Rebate | PHI Benefit | Out of Pocket |
| Blood Screening | $34.70 - $69.55* | $29.50 - $200 | $29.50 - $59.15 | $0 | $0-$140.85 |
| *Medicare Fee is approx. average cost which varies depending on what is being tested |
Week 16
16
| Costs | Medicare Schedule Fee | Doctor or Specialist Cost | Medicare Rebate | PHI Benefit | Out of Pocket |
| OB Visit - standard check-up to monitor you and your baby's health | $42.20 | $80 - $150 | 85% ($35.90) | $0.00 | $44.10 - $114.10 |
| Note: Your ongoing OB visits may be included in your planning and management fee if that has been agreed |
Week 20
20
At around 20 weeks, you may be due for an ultrasound and your OB may have given you a referral. This will check for the position of the placenta, the amount of amniotic fluid, baby's growth and detect any structural abnormalities in the foetus such as heart, limbs, abdomen, bones, brain, spine and kidneys.
At this time you’re also likely to have another visit to your OB. At this visit your OB is likely to carry out a standard checkup to monitor you and your baby's health. It’s a good idea to ask which hospital to book into for the birth (if you have not already done so), and ask what fees and charges you should expect for your delivery in that hospital. Ask your OB’s office to supply the paperwork required to book your place in the private hospital.
Once you have completed the forms, contact the hospital. You may need to meet with an admissions officer to provide them with your paper work. They may also show you the facilities and discuss any details of your hospital stay.
It is also time to book your antenatal classes. You are likely to commence classes around 32 weeks or earlier into your pregnancy. These will generally involve around 4-6 visits, depending on availability and other factors. Antenatal classes are not covered by Medicare, but may be covered by your health insurance. It's best to call us and check whether your classes are covered.
| Costs | Medicare Schedule Fee | Doctor or Specialist Cost | Medicare Rebate | PHI Benefit | Out of Pocket |
| 20 Week Structural Ultrasound | $150 | $150 - $300 | 85% ($127.50) | $0 | $22.50 - $172.50 |
 OB Visit - standard checkup to monitor you and your baby's health | $42.20 | $80 - $150 | 85% ($35.95) | $0.00 | $44.10 - $114.10 |
|
Antenatal Classes | $0 | $50-$400 | $0 | $50 -$400† | $0 - $400† |
| †Your PHI benefit for antenatal classes will depend on your level of cover and who provides the class. We recommend that you call nib on 13 14 63 before you book your classes and we can let you know if you’ll have any out of pockets to pay. |
Week 21
21
You should expect a call from your hospital as it will have completed an eligibility check with us just to ensure you have the appropriate level of hospital cover for pregnancy and birth related services in a private hospital. You will also need to ensure your payments to nib are up to date so you are fully covered.
The hospital will then advise of any costs you can expect which may include your hospital excess that may be payable now, or anytime up to your hospital admission.
Week 22
22
| Costs | Medicare Schedule Fee | Doctor or Specialist Cost | Medicare Rebate | PHI Benefit | Out of Pocket |
| OB Visit - standard check-up to monitor you and your baby's health | $42.20 | $80 - $150 | 85% ($35.90) | $0.00 | $44.10 - $114.10 |
| NB at 24-26 weeks a glucose challenge test is usually performed. If this is positive, your GP or Specialist will proceed to an Oral Glucose Tolerance Test to screen for gestational diabetes. |
Week 26
26
| Costs | Medicare Schedule Fee | Doctor or Specialist Cost | Medicare Rebate | PHI Benefit | Out of Pocket |
| OB Visit - standard check-up to monitor you and your baby's health | $42.20 | $80 - $150 | 85% ($35.90) | $0.00 | $44.10 - $114.10 |
| Your OB Planning and Management Fee may be due this visit | $318.05 | $1600 - $4500 | 85% ($270.34) | $0.00 | $1329.66 - $4229.66 |
Week 32
32
| Costs | Medicare Schedule Fee | Doctor or Specialist Cost | Medicare Rebate | PHI Benefit | Out of Pocket |
| OB Visit - standard check-up to monitor you and your baby's health | $42.20 | $80 - $150 | 85% ($35.90) | $0.00 | $44.10 - $114.10 |
Week 34
34
| Costs | Medicare Schedule Fee | Doctor or Specialist Cost | Medicare Rebate | PHI Benefit | Out of Pocket |
| OB Visit - standard check-up to monitor you and your baby's health | $42.20 | $80 - $150 | 85% ($35.90) | $0.00 | $44.10 - $114.10 |
Week 36
36
| Costs | Medicare Schedule Fee | Doctor or Specialist Cost | Medicare Rebate | PHI Benefit | Out of Pocket |
| OB Visit - standard check-up to monitor you and your baby's health | $42.20 | $80 - $150 | 85% ($35.90) | $0.00 | $44.10 - $114.10 |
Week 38
38
| Costs | Medicare Schedule Fee | Doctor or Specialist Cost | Medicare Rebate | PHI Benefit | Out of Pocket |
| OB Visit - standard check-up to monitor you and your baby's health | $42.20 | $80 - $150 | 85% ($35.90) | $0.00 | $44.10 - $114.10 |
Week 40
40
You may be due to have your baby!
You may need to pay your hospital excess (if you have one) upon admission to hospital. The hospital will put this amount towards your hospital fees, which will be billed directly to nib at the end of your stay.
Out of Pockets
If you receive a bill from your hospital after you’ve had your baby it may mean that you had additional out of pocket expenses during your stay, these may have happened if:
- Your obstetrician and anaesthetist (if you required one) decided not to participate in nib’s medical gap scheme to eliminate out of pocket expenses
- You required blood tests, scans, ultrasounds or other items that are not covered by nib’s hospital contract
- You used an ambulance for transport to/from/between hospitals when it was not medically necessary
- You or your baby had complications and were admitted as a private patient (if the opportunity is available you can ask to be admitted to a public hospital as a public patient to avoid unforseen costs)
You will also have an out of pocket cost for the Paediatrician who comes to check your newborn. Your healthy newborn baby is considered an outpatient. Health insurance cannot cover this service and Medicare will only pay part of the cost.
| Costs | Medicare Schedule Fee | Doctor or Specialist Cost | Medicare Rebate | PHI Benefit | Out of Pocket |
| Delivery Fee for your Obstetrician (uncomplicated delivery) | $681 | $681 - $7,500 On average nib customers are charged $1,360 | 75% ($510.75) | 25% ($170.25) | $0* - $6,154 On average nib customers pay $180 |
| nib Agreement Private Hospital Charges (uncomplicated delivery) | $0 | $4,000 -$10,000 | $0 | $4,000 -$10,000 | $0** |
| Anaesthetist (uncomplicated delivery) | $405.65 | $405.65 - $3,500 On average nib customers are charged $840 | 75% ($304.30) | 25% ($101.41) | $0* - $3,094.35 On average nib customers pay $460 |
| Paediatrician Consult for your newborn (no complications) | $148.10 | $250 - $400 | 85% ($125.90) | $0 | $124.10 - $274.10 |
| Hospital Excess(if you have one) | $0 | $0 | $0 | $0 | $0 - $500 nib’s most popular excess level is $500 |
| *If your specialist elects to charge the Medicare Benefit Schedule Fee or participate in nib’s MediGap scheme to eliminate out of pocket expenses. |
| ** No out of pockets assumes that you give birth in a private hospital under contract with nib. If you require items that are outside of nib’s hospital contract you may have out of pockets to pay. Please note that if you do not have health insurance and elect to attend a private hospital to have your baby your hospital charges are likely to be significantly higher than the charges you would experience as an nib private hospital patient. |
Week 46
46
After you’ve had your baby, and in most instances returned home from hospital you will require a check-up by either a midwife, your OB, Maternal Child and Health nurse or your GP – depending on what you’ve arranged. This is just to check the general health of you and your baby and make sure everything is healing as it should.
Don’t forget to call nib to add your newborn baby to your health insurance.
| Costs | Medicare Schedule Fee | Doctor or Specialist Cost | Medicare Rebate | PHI Benefit | Out of Pocket |
| Post partum check-up by midwife / OB assist or your your GP | $42.20 | $80 - $150 | 85% ($35.90) | $0 | $44.10 - $114.10 |
Note: This is an outpatient service and unable to be covered by health insurance
Average total costs
Total
| Costs | Medicare Schedule Fee | Doctor or Specialist Cost | Medicare Rebate | PHI Benefit | Out of Pocket |
Approx. Average Totals
(nearest $5) | $2,500 - $2,645 | $8,235 - $29,300 | $1,985 - $2,165 | $4,300 - $10,670 | $1,930 -$8,090 (based on nib’s average claims experience your out of pockets could be higher or lower depending on your circumstances) |
Totals are based on an approximate average range of costs in Australia. It shows that depending on which way you go; health system costs vary greatly and are usually impacted by your choice of GP, specialist, hospital and where you live in Australia (GPs and specialists in metro areas typically charge higher fees). Based on these average ranges you could prepare to incur somewhere between $1,930 - $8,090 in out-of-pocket expenses throughout your pregnancy. As always it’s best to check this information with us to find out how you can avoid some of these costs.
Tips to help you avoid out of pockets:
Tips
- If your specialists participate in your nib’s medical gap scheme, it is likely that Medicare and nib will pay for 100% of hospital costs; however, your specialist, OB or anaesthetist may charge more than the Medicare benefit schedule fee in which case, you may have an out of pocket cost.
- If your hospital does not have an agreement with nib, you are more likely to incur out of pocket costs
- Contact Medicare to discuss the Safety Net, your limits and what you can do to get the most benefits
- Ask your specialists for Informed Financial Consent of their fees and charges
- Be prepared for additional costs if there is an emergency or complications. It's unlikely that you'll have a choice of doctor in these situations; as a result it's difficult to check whether they participate with a medical gap scheme and you are likely to end up with out of pockets as a result. Don’t forget you can still ask them to consider medical gap even after the service
- Remember that your new, healthy baby will be considered an outpatient and any consultations or tests related to your newborn while you are both in Hospital will not be covered by your nib health cover
- The Extended Medicare Safety Net (EMSN) no longer covers 80% of the out-of-pocket costs for obstetrics. There is a cap on the benefit paid to obstetrics claims under the Extended Medicare Safety Net which generally increases out-of-pocket expenses during pregnancy. Medicare Safety Net changes relating to obstetrics 2009-10 Budget can be found here http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-EMSN
Costs Table
Costs Table
| Week |
Medicare Schedule Fee |
Doctor or Specialist Cost |
Medicare Rebate |
PHI Benefit |
Out of Pocket |
| Week 1–4 |
| GP Consult |
Time based up to $80.75 |
$35.60 - $150 |
Time based $35.60 for a 15 minute consultation |
$0 |
$0 - $69.25 |
| Week 6 |
| GP Consultation |
Time based up to $80.75 |
$35.60 - $150 |
Time based $35.60 for 15 minute consultation |
$0 |
$0 - $69.25 |
| Blood Screening |
$34.70 - $69.55 |
$29.50 - $200 |
$29.50 -$59.15 |
$0 |
$0 - $140.85 |
| Week 10 |
| First OB Consultation |
$83.95 |
$150-$300 |
85% ($71.40) |
$0 |
$79 - $228.60 |
| Week 11 |
| Blood Screening |
$34.70 -$69.55 |
$29.50 - $200 |
$29.50 -$59.15 |
$0 |
$0 - $140.85 |
| Ultrasound |
$150 |
$150 - $300 |
85% ($127.50) |
$0 |
$22.50 - $172.50 |
| Week 12 |
| Chorionic Villus Sampling (through the abdomen or cervix) |
$119.60 |
$550 - $1000 |
85% ($101.70) |
$0 |
$448.30 - $898.30~ |
| Amniocentesis (through the abdomen) this may be conducted at Week 14 or 15 |
$62.30 |
$550 - $1000 |
85% ($53.00) |
$0 |
$497 - $947~ |
| Week 15 |
| Blood Screening |
$34.70 - $69.55 |
$29.50 - $200 |
$29.50 - $59.15 |
$0 |
$0 - $140.85 |
| Week 16 |
| OB Visit - standard check-up to monitor you and your baby's health |
$42.20 |
$80 - $150 |
85% ($35.90) |
$0.00 |
$44.10 - $114.10 |
| Week 20 |
| OB Visit - standard check-up to monitor you and your baby's health |
$42.20 |
$80 - $150 |
85% ($35.90) |
$0.00 |
$44.10-$114.10 |
| 20 Week Routine Structural Ultrasound |
$150 |
$150 - $300 |
85% ($127.50) |
$0 |
$22.50 - $172.50 |
| Antenatal Classes |
$0 |
$50-$400
|
$0 |
$50 - $400† |
$0 - $140† |
| Week 22 |
| OB Visit - standard check-up to monitor you and your baby's health |
$42.20 |
$80 - $150 |
85% ($35.90) |
$0.00 |
$44.10- $114.10 |
| Week 26 |
| OB Visit - standard check-up to monitor you and your baby's health |
$42.20 |
$80 - $150 |
85% ($35.90) |
$0.00 |
$44.10- $114.10 |
| Your OB Planning and Management Fee may be due this visit |
$318.05 |
$1,600 - $4,500 |
85% ($238.55) |
$0 |
$1,361.45 - $4,261.45 |
| Week 32 |
| OB Visit - standard check-up to monitor you and your baby's health |
$42.20 |
$80 - $150 |
85% ($35.90) |
$0.00 |
$44.10 - $114.10 |
| Week 34 |
| OB Visit - standard check-up to monitor you and your baby's health |
$42.20 |
$80 - $150 |
85% ($35.90) |
$0.00 |
$44.10 - $114.10 |
| Week 36 |
| OB Visit - standard check-up to monitor you and your baby's health |
$42.20 |
$80 - $150 |
85% ($35.90) |
$0.00 |
$44.10 - $114.10 |
| Week 38 |
| OB Visit - standard check-up to monitor you and your baby's health |
$42.20 |
$80 - $150 |
85% ($35.90) |
$0.00 |
$44.10 - $114.10 |
| Week 40 |
| Delivery Fee for your Obstetrician (uncomplicated delivery) |
$681 |
$681 - $7,500 On average nib customers are charged $1,360 |
75% ($510.75) |
25% ($170.25) |
$)* -$6,154 On average nib customers pay $180
|
| nib Agreement Private Hospital Charges (uncomplicated delivery) |
$0 |
$4000 -$10000 |
$0 |
$4000 -$10000 |
$0** |
| Anaesthetist (uncomplicated delivery) |
$405.65 |
$405.65 - $3,500 On average nib customers are charged $840 |
75%($304.30) |
25% ($101.40) |
$0* - $3,094.35 On average nib customers are charged $460 |
| Paediatrician Consult for your newborn (no complications) |
$148.10 |
$250 - $400 |
85% ($125.90) |
$0 |
$124.10 - $274.10 |
| Hospital Excess (if you have one) |
$0 |
$0 |
$0 |
$0 |
$0 - $500 nib’s most popular excess level is $500 |
| Week 46 |
| Post partum check-up by midwife/obstetricians assistant |
$42.20 |
$80 - $150 |
85% ($35.90) |
$0.00 |
$44.10-$114.10 |
| APPROX. TOTALS |
$2,500-$2,645 |
$8,235-$29,300 |
$1,985-$2,165 |
$4,300-$10,670 |
$1,930-$8,090 (based on nib’s average claims experience your out of pockets could be higher or lower depending on your circumstances) |
| ~ Unless your First Trimester Screening indicated that you have an ‘increased risk’ of Down Syndrome or other chromosomal abnormalities you will not be required to pay for these tests. |
| †Your PHI benefit for antenatal classes will depend on your level of cover and who provides the class. We recommend that you call nib on 13 14 63 before you book your classes and we can let you know if you’ll have any out of pockets to pay.
|
| * If your specialist elects to charge the Medicare Benefit Schedule fee or participate in nib’s MediGap scheme to eliminate out of pocket expenses. |
| ** You will have out of pockets if you require items that are not covered by nib’s hospital contract |
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