Fee Disclosure – Obstetric Care
If you have a Medicare card and private health insurance with obstetric cover, your total out-of-pocket expense for pregnancy care with me is roughly $7,500.
These comparatively high out-of-pocket costs reflect the way Medicare and private health funds currently rebate specialist obstetric services. This estimate is provided so you can plan ahead with as much clarity as possible.
If you do not have private health insurance, your total out-of-pocket expenses will be roughly $8,500.
How billing is structured
To reduce these costs where possible, I use “No Gap” billing for the delivery fee when your private health insurance includes obstetric cover. This means the Planning and Management fee represents the main out-of-pocket component of your care.
This structure is designed to make the best use of the available Medicare and health fund rebates while keeping your personal contribution as clear and predictable as possible.
The Planning and Management fee is the main bill you will receive from me during your pregnancy, regardless of the complexity of your pregnancy or birth. If you have private health insurance with obstetric cover, your remaining payments to me are usually limited to antenatal visits at $180 per visit. I do not issue additional bills after the birth.
The Planning and Management fee
- Includes your contribution to my medical professional indemnity insurance (approximately $100,000 per annum)
- Assists with the costs involved in maintaining my office in the Eastern Suburbs.
- Acts as a retainer acknowledging the provision of 24-hour cellphone-based specialist availability.
- Covers visits by me if you attend or are admitted to hospital prior to giving birth.
- Covers all of your postnatal visits.
- Supports most midwifery services at my office, so visits with Marisa are not charged.
- Allows me to keep my patient numbers manageable so I can provide a highly personal and responsive service throughout your pregnancy.
Medicare rebates apply to eligible fees charged while you are not admitted to hospital. Your health fund generally covers in-hospital treatment, including the birth itself, according to the level of cover in your policy.
Out-of-pocket costs arise because Medicare and health fund rebates do not cover the true cost of providing specialist obstetric care. This care includes antenatal management, hospital care, postnatal review and 24-hour availability for urgent concerns throughout your pregnancy.
Fee schedule
| Item number | Type | Fee | Medicare rebate | Rebate after Safety Net | Out-of-pocket |
|---|---|---|---|---|---|
| 16401 | Initial antenatal consult | $400 | $84.80 | $152 | $315.20 / $248 |
| 16500 | Subsequent antenatal consult | $180 | $46.75 | $86.95 | $133.25 / $93.05 |
| — | Planning and Management fee deposit (payable at 20 weeks gestation) | $3,300 | — | — | — |
| 16590 | Planning and Management fee balance (payable at 28 weeks gestation) | $3,300 | $369.65 | $638.35 | $5,661.65 |
If your private health insurance covers you for obstetrics, I will “No Gap” the delivery fee. This means I will bill your health fund directly for the cost of the delivery, with no additional payment required by you.
Delivery fee if you do not have private health insurance
| Item number | Type | Fee | Medicare rebate | Out-of-pocket |
|---|---|---|---|---|
| 16519 | Uncomplicated | $1,500 | $707.15 | $792.85 |
| 16522 | Complicated | $2,200 | $1,425.55 | $774.45 |
Postnatal visits
Postnatal visits will be billed to Medicare.
Please note: costs not included in my fees
My fees do not include the following costs. These figures are very rough estimates.
- Ultrasound scans: performed by specialised ultrasound services. You will require at least two ultrasound scans per pregnancy.
- Laboratory tests: tests conducted on the Randwick hospital campus at the SEALS laboratory are bulk billed. You may wish to have your blood tests performed there rather than DHM.
- Anaesthetists’ fees: depending on the situation and the time of day or night, anaesthetists’ fees can range from approximately $1,500 for a straightforward epidural insertion to over $3,000 for involvement in complicated labours involving epidurals, caesarean sections or complications after the birth. Your health fund will refund approximately half of these fees.
- Surgical assistant fees: for caesarean births. A surgical assistant is compulsory in Australian hospitals. The cost is approximately $700, with approximately $200 rebated by your health fund.
- Private paediatric services: private paediatric services provided within the hospital.
These services are provided and billed separately by the relevant providers, so the final amount may vary depending on your individual circumstances and your health fund cover.
These costs are separate from my fees and are set by the individual providers or hospital involved in your care. I recommend confirming these costs directly with the relevant provider or your health fund.
Please note: Hospitals charge accommodation fees for the hospital bed, nursing and midwifery care, and theatre fees where applicable. These costs are usually billed to your health fund if you have appropriate pregnancy cover. If you do not have pregnancy cover, the hospital may bill these costs directly to you. Please contact the hospital finance department for the most current estimate of their fees.