Frequently Asked Questions

Paediatric Care at Birth

Will my private health insurance cover my invoice for my child’s care?

Medicare rebates paediatrician fees, for the care of most babies’ stay in hospital with their in-patient mother. These babies are “non-admitted” or outpatient neonates.

Some newborns are formally admitted as an inpatient because they need extra care in the nursery. If appropriate family cover policy applies, the family’s health fund rebates this in-nursery/ inpatient care by the paediatrician.

Inpatient care is normally invoiced to the family’s private health fund once their baby is enrolled with Medicare. A gap amount may then be invoiced to the family.

WHY ARE BABIES ADMITTED?

Your baby may be formally admitted, as a hospital nursery inpatient for phototherapy, oxygen therapy, injected or IV antibiotics, a glucose drip or other need for closer supervision and care. Caesarian birth or a short visit to the special care nursery directly after birth for breathing difficulties or warming up does not qualify as a formal admission.

INVOICING AND CLAIMING FOR ADMITTED CARE

In the case of formal admission as an inpatient, this portion of the account will normally be invoiced directly to your private health fund. It is important to promptly register your baby for Medicare and on your health fund policy. Where your health fund is invoiced, there may be a gap amount not covered and this will then be invoiced to you.

If your family is self-insured or not covered by Medicare (e.g. overseas visitors), the invoice for your baby's admitted care will be sent to you with inpatient item numbers listed with an asterisk (*) next to them for claiming purposes. Once paid, overseas visitors can present their receipt to their health fund or the self-insured registered with Medicare will be able to claim applicable Medicare rebates.

The hospital said there wouldn’t be other expenses?

The hospital advises its hospital charges and not the fees for the doctors who must be involved in caring for the mother (obstetrician, perhaps an anaesthetist) or the new baby (paediatrician ) There may still be other fees for services not directly under the responsibility of the hospital such as, medicine costs, pathology services and other physician reviews.

Your obstetrician will refer your baby, at birth, to a paediatrician who then undertakes 24/7 medical responsibility for your baby during their stay in hospital. This specialist paediatric care is essential to your baby's stay in the hospital.

How much is the Gap? (Medicare-eligible patients only)

Your maximum gap is advised on your invoice. Your final gap may be much less than this if you you are paid Medicare Safety Net rebates. Most families reach the Safety Net threshold following payment of their Obstetrician’s account prior to the maternity hospital admission.

The standard gap will reflect the nature of the attendances needed for your newborn baby. Most newborn babies are checked and assessed during their paediatrician’s rounds and the invoice will have the lowest gap. Planned attendances at C-sections require more time and the gap on the invoice will be higher. The highest gap will result when your paediatrician needed to make at least one unplanned attendance to your baby. Families should budget for the highest gap for their baby’s care in the hospital following delivery, just in case an unplanned attendance is needed,

What is the Medicare Safety Net Scheme and how does it affect me

Once your family has reached a Medicare Safety Net threshold for health care expenses, Medicare provides additional rebates to limit further gap costs. Make sure both parents, the baby, and any siblings, are all registered and linked as a family with Medicare so you get the full benefit of the thresholds. At the first threshold of out-of-pocket costs in a calendar year, Medicare rebates any further scheduled fees paid in that year. At the second threshold, Medicare rebates 80% of the remaining gap. Families with concession cards are eligible for these rebates and lower expense thresholds. The government may adjust the threshold amounts required under the scheme in the Federal Budget. You can find out more at https://www.servicesaustralia.gov.au/medicare-safety-nets . You can check your eligibility on myGov.

how do we pay the account?

See our Fee Payment Policy for details.

Why do you require payment of the account in full?

Our policy results in the best outcomes for families as the wait between payment and rebates is minimised and ensures your Safety net rebates are paid if eligible. Our policy also helps to avoid unnecessary costs for Prosper Paediatrics in administering billing which helps keep fee increases to a minimum. We have managed the care, the billing and the rebate claiming for well over 8000 neonates over the years. We are experts in neonatal billing and in making it as easy as possible for families.

concerns about managing the payment

Enrol your newborn in Medicare very soon after birth. Medicare takes around 4 to 6 weeks to process newborn enrolments.

Medicare normally pays rebates to families within 24 hours of the payment being receipted and the rebates claimed.  

If concerned, we advise families to pay in the morning over the phone or via our website payment portal,and ask staff to lodge a Medicare claim for them as early as possible in the day. Very often this results in rebates arriving in your bank account by the end of the day. For most families, additional Safety Net rebates ensure that most of your payment is rebated.

Request an itemised payment plan if the total amount of the invoice will be difficult to manage in one payment. Your baby should be Medicare enrolled.

What if my baby doesn’t have a Medicare number yet?

While we appreciate prompt payment, we understand that there can be delays in receiving your baby’s Medicare number. If this is the case, we are happy to delay payment until the 6th week after birth. We ask that all accounts are settled by this time.

Prescriptions

Medication:

Your paediatrician may prescribe a medication for your child in light of their assessment and diagnosis of your child's need. They will advise how to begin the medication and how to manage expected side effects. There may be some serious side effects that should be advised to your doctor without delay if they occur. Sometimes the medication should be stopped quickly or gradually, as advised by the pediatrician. Your child will need to be reviewed in appointments to see how they are responding to the medication and monitor and manage any side effects. You should always follow your paediatricians' instructions and advice when administering the medication.

Repeat prescriptions

Please provide at least a week’s notice when requesting a repeat. An appointment will normally be required to review your child's progress and evaluate the medication's effects. Sometimes your paediatrician can issue a repeat and then have this review at a later time.

Authority Medications and repeat scripts

The prescription of certain medications, such as stimulant medications for ADHD, is regulated more closely under State and Federal Law. Regulations vary from State to State. this FAQ is from the perspective of SA Regulations.

Your paediatrician must apply for a Drugs of Dependence Authority from the State regulator to prescribe this medication to your child. If your paediatrician with the Authority is away, another paediatrician practising with Prosper Paediatrics can issue a script on their behalf. Your child's GP may be able to issue the script in consultation with the authorised paediatrician. However, many GPs prefer not to do this and report that the regulations make it very difficult and impractical. Please always aim to give your paediatrician plenty of notice and at least a week when you need a new script. Generally, your pediatrician will need to see your child in an appointment to review how they are going with the medication. A minimum of 6 monthly reviews are required, and a physical check-up is usually needed.

Can my new paediatrician prescribe the Authority medication?

Your previous paediatrician can apply to revoke their Authority if you change to a new paediatrician in a different practice. One of either your new paediatrician, child's GP or psychiatrist can then apply for the Authority. If your GP takes on the Authority, your child may need to be reviewed by their paediatrician or psychiatrist from time to time.

Many GPs prefer a paediatrician or psychiatrist holding the Authority. As an interim arrangement, your child's GP may be able to issue prescriptions for the medication for 2 months following the revocation of the previous doctor’s Authority before a new paediatrician or child psychiatrist applies for the Authority. Please liaise carefully with your GP, and old and new paediatricians when making a change.

We understand the difficulties for families and their children in managing under these regulations and when a change of prescriber is needed (such as due to an interstate move). However, these situations are generally not able to be triaged as urgent.

why is there a fee for prescriptions issued outside and appointment?

When a script change or renewal is requested, your doctor must open and check your child’s record, including their management plan, any issues with side effects, previous prescriptions and expiry dates. For Authority Prescriptions, they must phone the Authority to obtain authorisation and this can take some time. Extra work is needed if there are supply issues and an alternative strength or alternative medication needs to be subsituted. This work is additional to the routine medication and management reviews that is part of any appointment.