Mum’s pregnancy surprise reveals insurance mistake

Kylie was elated to discover she was pregnant with her first child but her feeling turned to panic when she realised she’d made a costly insurance mistake.

There can be waiting periods on a new policy for pregnancy related procedures so it’s worth checking your cover. Picture: iStock

Unexpectedly falling pregnant with her first child, Kylie hadn’t changed her private health insurance for pregnancy cover. Ensuring her second pregnancy was covered by private health insurance, she says the two experiences couldn’t have been more different.

I was at work when I first discovered I was pregnant. Suspiciously ‘late’ and feeling a bit ‘off’, on a whim I’d visited the chemist during my lunch break to buy a pregnancy test and slipped into the ladies’ bathrooms that afternoon to give it a go.

Pregnancy wasn’t on my radar at the time. I’d just turned 30, was living with my now-husband in a small semi in Sydney’s inner-west and enjoying all the freedom that comes with childless coupledom. So, when I first laid eyes on those two undeniable straight lines on the test stick that day, my first reaction was shock, which quickly evolved into elation and then plunged rapidly into abject panic.

HINDSIGHT IS 20/20

At the time, I had money in my pocket, but very little savings and I hadn’t thought much about the ‘singles’ private health insurance policy my mum had arranged for me when I’d left home a decade earlier.

It was only after my first obstetrics appointment that I realised, in hindsight, what a fool I’d been for not reviewing my health insurance before then.

Paying for my first private obstetrics consultation, my private health cover was declined and the receptionist said, “I’m afraid your policy might not provide cover for obstetrics” and charged me the full amount for the appointment.

Later that day, I contacted my insurer who confirmed my policy didn’t have pregnancy cover and that I’d have a 12-month waiting period on a new policy for pregnancy related procedures if I were to upgrade that day. It was too late – I was already three-months into my pregnancy and it was then I realised it was going to be a very different experience to the one it could have been, had I had the foresight to review my insurance cover sooner.

Kylie and her new baby daughter. Picture: Casimir Bratkowski

CARE – BUT WITH LIMITATIONS

We’re lucky in Australia to have Medicare as our public health system and it was to this I turned when I realised I was without private health cover. Throughout my pregnancy and birthing experience, I received wonderful care through Medicare for which I’ll be forever grateful. But it did come with limitations.

Rather than choose my preferred obstetrician throughout my pregnancy, I’d see a different health care professional at every appointment. Also, I wasn’t able to select appointment times that suited my busy work schedule and would often be left waiting for hours over the scheduled appointment time to see my designated healthcare professional.

I gave birth to my baby girl in a large Sydney hospital, enduring a 12-hour labour that ended in a dramatic emergency C-section. Afterwards, I shared a room with another first-time mum and her newborn and between our varying schedules for check-ups, tests, excited visitors, emotional spouses, screaming babies and breastfeeding woes, there was very little rest or privacy for either of us.

LESSONS LEARNED

I vowed after that experience that even if I never planned to have another child, I’d change my private health insurance policy to cover pregnancy ‘just in case’. And a good thing I did, too, because just 14 months later, another wonderful little surprise pregnancy revealed itself in dramatic fashion while I was in Hobart celebrating my hen’s weekend (but that’s a story for another time…).

My second pregnancy and birthing experience was covered by private health insurance and proved to be a far more manageable affair. I was able to choose my own obstetrician, who provided me with consistent care throughout my pregnancy and welcomed my son into the world with a scheduled, low-key C-section in the hospital of my choice. I also had the privilege of a private room – where I found rest still elusive, but my privacy and comfort assured.

WHAT IS PREGNANCY HEALTH INSURANCE?

Pregnancy cover is pretty much self-explanatory – it’s private health cover for a range of care options for parents. This cover ensures parents have some choice in – and control over – their care and provides peace of mind during the pregnancy and birth of their baby.

Only some health insurance policies have pregnancy cover, so if you are planning on having a family in the future – or in a situation where it’s not planned but may happen – you should choose a health insurance policy with pregnancy cover.

WHAT DOES PREGNANCY HEALTH INSURANCE COVER?

Depending on the insurer and the policy you choose, pregnancy cover may provide:

Hospital (and hotel) accommodation (sometimes of your choice)

Theatre and labour ward fees

Hospital-administered pharmaceuticals

Access to the special care nursery (if you’re on a family or single parent cover)

Medicare Benefit Schedule fees

Intensive care (during and after birth)

Some insurers may require you to have this cover in place for a set period of time prior to access to these benefits. This is often a 12-months period, but it may vary depending on insurer, policy and even a promotion the insurer is offering. You will need to compare relevant insurance policies to select the policy with pregnancy cover that will suit your requirements and priorities.

HOW CAN IT COMPARE TO USING PUBLIC MEDICARE COVER?

Medicare cover will also provide parents with excellent care during your pregnancy and birth, however, your experience will depend on where you live, the resources available in your local area, what your personal priorities are and the facilities available at your local public hospital.

Public care will also ensure you have very few, if any, out-of-pocket expenses but you won’t necessarily get to choose your hospital or healthcare professionals and, unless you get lucky, you’ll probably share a room with another new mum and her baby. Also, depending on the hospital and its resources, the food and facilities may not be as ‘nice’ compared with the private hospital experience.

HOW MUCH DOES PREGNANCY HEALTH INSURANCE COST?

This will vary depending on your own requirements as well as the policy and insurer you choose. Review your personal budget and priorities and compare policies to determine which will suit your family best.

You will need to pay the excess for hospital admission on your private health policy and may also incur significant and sometimes unexpected costs for care and procedures not covered by your policy. For this reason, make sure you know exactly what your policy covers beforehand to avoid any nasty financial surprises.

Out-of-hospital care is not always covered in your policy or may be part of ‘extras cover’ so you will also need to check you are covered and how much, if any, Medicare might also cover. These may include:

Some specialist outpatient consultations

The ‘gap’ on medical services incurred in hospital.

Appointments made when not an inpatient, such as outpatient ultrasounds

Elements of IVF treatments

Pre-release check-ups

Your obstetrician may also charge a “pregnancy management fee” and while Medicare and your health fund will pay something towards this, you may be left to pay the ‘gap’. You should also find out how much your obstetrician charges over the Medical Benefits Schedule as well as any caps on fees covered by the Medicare Safety Net.

This article was created in sponsorship with iSelect.