Choosing a private hospital for delivery means choosing private care for your newborn. At or after birth, your baby will be referred to a paediatrician.

Prosper Paediatrics-associated Paediatricians and Neonatologists are accredited with and care for newborns in

• Burnside War Memorial Hospital

• Calvary North Adelaide Hospital

• Ashford Hospital

  
  

Many families would like to have (or start) continuity of care with a preferred paediatrician.

You may be hoping to have the same paediatrician who cared for your previous baby or is caring for your children when organising admission for the birth of a younger sibling.

Or you may be hoping to try a paediatrician who has been recommended to you by friends or family. 

Your obstetrician will organise a referral to your preferred paediatrician as long as they are accredited to care for neonates at your chosen hospital and they are able to accept your baby's referral at that time.

• Your private hospital has several accredited paediatricians to ensure choice and safe levels of paediatric coverage for newborns.

• Let your obstetrician or the midwives know your preferences regarding your paediatrician.

• If you are having a Caesarian delivery, you can ask that your obstetrician book your preferred paediatrician for the delivery when possible.

• If your preferred paediatrician is not available for all or part of your newborn's care, the allocated doctor will be happy to refer your baby to your preferred paediatrician, when possible, or for follow-up care.

• Choosing a private hospital maternity service allows you to choose your paediatrician where possible.

• For many families, the healthcare relationship with their paediatrician may be very important and may extend to 18 years or more.

Our Associated Paediatricians and neonatologists collaborate to provide reliable 24/7 coverage for newborns.

Our associated neonatal doctors are strongly committed to providing reliable around-the-clock cover to the maternity units at Burnside War Memorial Hospital. They work closely together in a roster to ensure that any baby in urgent need of care can be attended quickly. Your obstetrician or midwife will know who to call to request advice or an urgent attendance. No time will be wasted.

Your paediatrician’s care of your newborn:

Your newborn’s paediatrician checks your baby thoroughly in a detailed newborn check after birth. They attend C-section deliveries and some other deliveries where there are extra concerns about the newborn. The paediatrician will be ready to identify any issues needing urgent care. After the newborn check, they then assess your baby’s progress during the hospital stay. They conduct standardised checks and monitoring each or most days and may direct or administer some treatments for your baby. Normally, they visit or check each baby during their “rounds” but are on-call around the clock for any issues and will attend at any hour if needed.

If your paediatrician is unable to provide care at any stage, they will ask a colleague to act as a locum. Your paediatrician will stay in touch with the midwives to keep alert to any issues or concerns, including questions or worries you may have.

Before you take your baby home, your paediatrician will see your baby for a thorough discharge check, discuss any concerns, and recommend follow-up care. Neonatal billing is structured around the brief and more involved checkups during the hospital stay.

Once home, your midwives and CAFHs will be important in helping with settling in, feeding, and growth checks. Your GP will love to meet your new baby, provide vaccinations and help with concerns. Your paediatrician, as a newborn care specialist, is supported and assisted by your GP and nurses and will see your baby for any concerns that emerge. Your paediatrician will also offer an appointment for an important health, growth and developmental check of your baby at 6 to 8 weeks of age. This check-up should not be missed.

Some paediatricians book these check-ups, but if not, please call to organise the 6 to 8-week check. You may also need to call to check the details or change an appointment time.

Your paediatrician and the Prosper Paediatrics staff love seeing babies for six-week checks. However, your GP may be happy to do this if you prefer.

Follow-up care is offered ongoing for as long as or when your baby, child or adolescent may need specialist care. Continuity of care is a priority for us and is supported by neonatal specialists and paediatricians who are always happy to provide backup for each other if needed. 

Your neonatal care invoice amount will depend on:

1.   Your standard maximum gap.

This is the portion of the fees not covered by standard Medicare rebates or, if for admitted care, your health fund’s payment. The accredited associated paediatricians understand the need for parents to plan their care costs. In addition, they aim to accommodate the health fund’s maximum known gap requirements. Each paediatrician’s billing decisions are made at their discretion.

1. The maximum out-of-pocket cost for your account will be $600 ($850 max for twins).

2. This gap may apply where, during your baby’s stay in the hospital, an attendance to your baby is required for

   • an out-of-hours planned C-section.

   • an unplanned urgent need for assessment and care.

3. Families should budget for this in case this kind of attendance is needed.

4. Most families’ gap will be less than this. The standard gaps for C-section and non-surgical deliveries are detailed on the paediatricians’ web pages below.

5. Most of the gap for your invoice is usually on the first billed item for the newborn check using item 122 (or item 110 for admitted babies.)

6. Most families will also be eligible for substantial additional Medicare Safety Net rebates.

7. You can check Safety Net eligibility for your baby and family with Medicare.

2.   Care needs of your newborn:

In addition to your gap, the invoice amount will also reflect the duration of your baby’s time in the hospital and the number of paediatrician attendances or checks needed. Your paediatrician will see your baby on most or all days of their stay but more often if needed. Paediatricians usually bill the scheduled fee using items 131 or 119 for briefer checks and 128 or 116 for discharge checks or other more involved checks.

3.   Your gap is capped regardless of whether your baby needs lots of care or only stays a few days.

What services are billed?

Your paediatrician’s attendances to (checks of) your baby are billed. Some attendances need to be very detailed; others very brief. Your paediatrician is responsible around the clock for your baby during their stay in the hospital. They will check your baby’s progress most days on their rounds with standardised monitoring and examinations. They stay in touch with the responsible midwives and may attend to your baby more often and at any hour if needed. They will arrange for another paediatrician to cover their responsibilities as a locum if they cannot come themselves. If a locum is needed, their care is billed in a separate invoice, but the gap for your account will still be capped as above.

Your Paediatrician’s Invoice

When will we receive the invoice?

Prosper Paediatrics will email your paediatrician’s account to you around two weeks after discharge. To allow sufficient time to enrol your baby in Medicare, the due date for payment will be the day when your baby is six weeks of age. 

admitted care invoices

These are submitted to your family’s health fund if you have applicable cover. There may be a gap after the Fund’s remittance. Families who are self-insured will normally be able to access some Medicare rebates following full payment of the account.

Families without Medicare should settle their account in full and then submit a claim to their fund.

Concerns about managing the account?

These normally resolve once families have gained a better understanding of Medicare rebates, the role of health funds, and ADF or DVA assistance. If needed, we can offer a payment plan to allow settlement of the account with a reduced outlay over several agreed itemised payments on consecutive mornings.  

The Reason for our Fees:

Fees are set to ensure the sustainable provision of excellent, evidence-based private paediatric neonatal care services. We aim to ensure accounts are manageable for those families who choose to deliver in a private hospital. Our payment policy aims to avoid unnecessary administrative costs, impacting services and fees, and unnecessary stress or extra cost for you. We love having babies visit us and feel enormously privileged to share a long-term journey with many children and their families following a newborn referral. We aim to ensure this first account is as manageable as possible.

How to pay? Payment of the whole invoice is required

Once receipted and as soon as we know your baby’s Medicare details, we can lodge a rebate claim.

Your Provider’s Fee Payment Policy sets out the payment methods, terms, conditions, requirements, and how we manage account settlement delays, including Late Fees and a Debt Recovery Fee. This policy helps keep services sustainable and billing fair for all parents.

Rebates and Reimbursement for non-admitted care invoice payment

Medicare Rebates -these are normally paid within about four business hours of claim lodgement (including standard and Safety Net rebates). Rebates are paid to your nominated bank account.

Gap cover for ADF and Veteran parents provides very similar reimbursement to Medicare except that reimbursement takes longer to process.

No Medicare?-you should pay the invoice and present your receipt to your health fund.

Rebates are claimed and paid in one quick step normally within about four business hours of payment. For most families, the rebates reduce your final gap substantially. Most find they receive most of their payment back.

Managing your account will be easier if you ensure the following:

❏ 1. Medicare: apply to enrol your baby as soon as possible after birth. All Australian citizens and permanent resident babies are eligible for enrolment with Medicare (including children of Veteran & ADF parents). Medicare takes around four weeks to process the enrolment. (More info about enrolling your newborn with Medicare here )

❏ 2. Safety Net Scheme: when enrolling your newborn, ensure you register them with you for the Medicare Safety Net Scheme. (more info on Safety Net & your baby here )

❏ 3. Health Fund: After delivery, contact your Fund to request your baby’s inclusion in your family health coverage from the date of their birth. Parents can self-insure.  ADF & Veteran parents can obtain a health insurance policy for their baby.

❏ 4. ADF parents should register their baby promptly for ADF Family Health Program on their profile (providing the birth certificate) to allow access to the Family Gap Cover scheme. (gap cover reimbursement can take a number of weeks).

4) Newborn Information Form: Complete this online form if your newborn has been referred to one of our paediatricians. 

5) Email -we use email for most correspondence. Please ensure that you add our address to your address book or contacts in your email program (on the handout given to you in the hospital). Please also provide your email address to us.

Neonatal billing basics:

Most newborn care is non-admitted and rebated by Medicare after payment. This includes babies of Veteran or ADF parents. Non-admitted newborns mostly ‘room-in’ with their mum during their hospital stay. Your Health Fund does not cover this.

Some newborns need admitted care in the Hospital Nursery for medical reasons. Admission to the Nursery can be brief or for many days. Some babies are taken briefly to the nursery for quick treatments such as warming, but this is not classified as admission. Admitted care is covered partly or fully under your private health policy (including for babies of Veteran & ADF parents) unless you self-insure. Following your health fund’s payment, any remaining gap is billed to you.

 Health funds require that babies are enrolled with Medicare before they will cover any fees for admitted care in the hospital nursery (includes babies of Veteran & ADF parents).

 No Medicare? If your baby is not eligible for Medicare, you must settle your account in full and then present your receipt to your fund.

 DVA & ADF member’s dependents?-see above for further information. Your baby’s Paediatrician will not be a registered DVA provider.

Gaps. There will be a gap. The maximum gap for a newborn’s care will be $600 but will often be smaller. The standard gaps for each paediatrician are advised on their web pages below. The Safety net may further reduce the gap.

Please phone or email us and ask to speak with the Practice or Accounts Manager if you have any questions or concerns.

The neonatal paediatricians post their neonatal fee gap schedules on their individual web pages below.

Paediatricians and Neonatologists associated with Prosper Paediatrics who offer Newborn Care in Hospital