Pregnancy & birth

Your Cover





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Your obstetrician

Once your pregnancy is confirmed, you’ll want to lock in an obstetrician. Sooner rather than later, as they can get pretty booked up.  

You could go with a recommendation from your GP, friends or family. Or do your own research via a tool like HealthShare. Or – if this isn’t your first bub – you may reach out to a doctor who’s looked after you before.


Understanding the costs

While preferences around things like experience and doctor/patient rapport may vary from person to person, getting value from Hospital cover tends to be a common goal!

The information below should help on the doctor front. Hospitals bill you separately, so we cover that in the next section (aptly named Hospitals).

Inpatient care

If Pregnancy and birth are 'covered' or 'restricted' on your Hospital cover, you can claim for treatment you get when you’re admitted to hospital. In an ideal world, this will be the safe arrival of your bundle of joy!

You’ll find more detail in Choosing a specialist, but here’s an inpatient costs 101:

  • The Medicare Benefits Schedule (MBS) is a detailed list of fees the government has set for medical services, including specialist treatment. Each item on the list has a unique code (or item number)

  • When you use your Hospital cover, Medicare pays 75% of the MBS fee per item number and we pay 25%

  • If your specialist charges more than the MBS fee, there’ll be a shortfall – known as ‘the gap’ – which you’ll have to pay

  • You can avoid large gap bills if your specialist agrees to treat you under the Access Gap Cover scheme

  • If they do, you’ll either have a known gap of up to $800 per doctor, or (even better) no gap at all!

  • The same rules apply for any other specialists involved in your inpatient care (e.g. anaesthetist, assistant surgeon, paediatrician or pathologist).

Outpatient care

Unless complications land you in hospital, your antenatal (pregnancy) care will fall into the outpatient basket. Think appointments, check-ups, scans, pathology and other tests.

Non-medical costs

The obstetrician’s pregnancy management fee is the biggie here. Medicare may contribute a small amount, but the rest is down to you. So be sure to ask your doctor about that one, and any other fees you should know about.


You must remember this…

That’s a lot to digest, but if there’s one key take-away, it’s to ask questions.

As noted in our Going to hospital guide, only once you’ve seen, understood, and okayed an estimate of all the specialists’ costs can you sign those Informed Financial Consent forms.

Please don’t worry about being annoying or looking silly – if the answers don’t make sense, keep asking until you’re confident about who’ll be paying for what. Assertive questioning is way better than stressing over unexpected bills while tending to a newborn.


Action items

Here’s a list of questions that could make you the smartest patient in the room!

Are you taking new patients?

Will you treat me under Access Gap Cover?

What’s your pregnancy management fee?

Are there any other (out-of-pocket) costs I should know about?

Can I have a breakdown of all the expected costs (including MBS item numbers)?

What does a typical appointment schedule look like?

What happens if you’re away/unavailable when I have my baby?

Which hospital(s) can you deliver babies in?

The last one is important because hospital bills can be another big-ticket item. We tackle that one in Hospitals.