Neonatal Care in Hospital: Your Paediatrician’s Invoice
Your Paediatrician’s Invoice
Five “TO DOs” following birth:
To avoid any difficulties with your neonatal care account, ensure you attend to the following as soon as possible after birth (ideally before discharge)
❏ 1. Medicare enrollment:
Submit the enrolment form for your baby to Medicare using the Declaration of Birth.
All Australian citizens and permanent resident babies are eligible for enrolment with Medicare (including children of Veteran & ADF parents).
Medicare takes around two weeks to process the enrolment.
Go to enrolling your newborn with Medicare here )
❏ 2. Update your Family Safety Net with Medicare:
Ensure you register them with you on your Family Safety Net with Medicare. Most families are eligible for an additional rebate of up to 80% of the gap (& any gaps for the remainder of the calendar year).
Go to Safety Net & your baby here
❏ 3. Notify your Health Fund:
Notify your Health Fund to request your baby’s inclusion in your family health coverage from the date of their birth.
Alternatively, parents can self-insure, but their maximum gap may be a little higher as Medicare rebates for admitted care are less than those provided by health funds.
ADF & Veteran parents can obtain a health insurance policy for their baby.
❏ 4. ADF parents should
Enrol their baby with Medicare and update their health fund family policy;
Register their baby promptly on their ADF Family Health Program Profile to allow access to the Family Gap Cover scheme. ADF mothers are not eligible for rebates under the Medicare Safety Net for their obstetrician and other medical costs. The family can instead access reimbursement for their baby’s specialist care gap, which is very similar to the Safety Net rebates.
Gap cover reimbursement can take several weeks, and you will need to provide the birth certificate.
❏ 5) Ensure you can be contacted by phone, and we can correspond by email.
Enter our email address into your Email Contacts (the address is on our handouts and provided in reply to the Newborn Information Form or our Contact Form)
Enter our phone number 8332 3778 in your phone contacts list.
Please also provide us with your email address.
Complete the Newborn Information Online Form
When will we receive the invoice?
Prosper Paediatrics will email your paediatrician’s account to you around two weeks after discharge. If your baby was admitted for all or part of their hospital stay, the invoice may take a bit longer. The invoice is for the care your paediatrician provided to your newborn during their hospital stay.
The due date for settlement
To allow sufficient time to enrol your baby in Medicare and register them on your health fund policy, the due date for payment will be the day when your baby is six weeks of age or two weeks after the invoice is issued, whichever is later.
Newborns eligible for Medicare
All eligible newborns should be enrolled with Medicare without delay so that families can claim
Medicare rebates for their payment for non-admitted care
Healthfund cover for any admitted care, but, ensure you also register your baby with your health cover policy from their birth.
Newborns not eligible for Medicare
Families must settle their paediatrician’s account in full.
Families can then submit a claim to their Health Fund using our receipt. They should ensure their baby is registered with their fund for cover from birth.
Your neonatal care invoice amount will depend on:
1. Your standard maximum gap.
2. The care your baby needed during their stay.
The 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. They will meet the health fund’s maximum known gap requirements.
Each paediatrician’s billing decisions are made at their discretion. But for your certainty and planning for out-of-pocket costs, the associated neonatal care doctors advise their gaps on their webpages.
For neonatal care with any of the associated neonatal care doctors:
The maximum out-of-pocket cost for your account will be $750 ($850 max for twins).
This gap may apply where, during your baby’s stay in the hospital, attendance to or consultation for your baby is required for
an out-of-hours planned C-section.
an unplanned urgent need for assessment and care.
Families should budget for this in case consultation or attendance of this kind is needed.
Most families’ gap will be less than this. Each paediatrician’s maximum gaps are detailed on their web pages (linked below).
Most of the gap for your invoice is usually included on the first billed item for the newborn check using MBS item 122 (or item 110 for admitted babies).
Admitted care items are rebated with 75% of the MBS item Fee (Scheduled Fee). Non-admitted care items are rebated at 85% of the item Fee.
Most families will also be eligible for a substantial additional Medicare Safety Net rebate, and we urge families to ensure they have registered their baby with their Medicare Family Safety Net.
At the first threshold of the Safety Net, the MBS Item Scheduled Fee is rebated for each item. This results in a final gap that is around 15% lower than the standard gaps advised here.
However, most families will be eligible for the second threshold Extended Medicare Safety Net (EMSN) rebate, covering 80% of the standard gap. So, if your standard gap is $750, your EMSN gap could be as little as $150 if you are eligible.
Safety Net Rebates are not available when a baby has had only admitted care in the hospital.
You can check your baby's and family's Safety Net eligibility with Medicare.
Care needs of your newborn:
In addition to your gap, the invoice amount will also reflect the duration of your baby’s hospital stay and the number of paediatrician attendances or checks required. Your paediatrician is responsible for your baby around the clock during their stay in the hospital and will see your baby on most or all days and, if needed, more often and at any hour. Paediatricians usually bill the scheduled fee using MBS items 131 (or 119 when admitted) for briefer checks and items 128 (or 116 when admitted) for discharge checks or other more involved checks. 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.
3. Your gap is capped regardless of whether your baby needs lots of care or only stays a few days
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. Prompt completion of the above To Do list will ensure that all applicable rebates can be claimed upon payment. Medicare typically pays these within about 4 hours of a claim.
An itemised payment plan may be agreed
This may be offered at the Manager's discretion to allow settlement of the account with a reduced outlay over several agreed, itemised payments on consecutive mornings. If you wish to request this, please ensure you have promptly completed all applicable steps on the To Do list above and contact us well before the due date for your account.
Admitted care invoices
These are submitted to your family’s health fund if you have applicable cover. There may be a gap (up to the maximum advised above) after the Fund’s remittance. 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).
Families who are self-insured will normally be able to access Medicare rebates following full payment of the account. However, your maximum gap may be a little higher than maximum advised as the rebates are lower than those paid by the Health Funds. If you have concerns or require further details, please email for the attention of, or phone and ask to speak with a Manager.
Families without Medicare must settle their account in full and then, using our receipt, submit a claim to their fund.
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.
The associated Paediatricians and Neonatologists offering Newborn Care in Hospital
Dr Brian Conway Consultant Paediatrician ABN 51 044 375 709
Burnside, Calvary North Adelaide & Ashford Hospitals
Dr Kavita Rasiah| Consultant Paediatrician | ABN 90978767995
Burnside Hospital
Dr Lydia Kennedy Consultant Neonatologist ABN 763151896
Burnside Hospital
Dr Rebecca Holst Consultant Paediatrician ABN 62978234528
Burnside Hospital