Unfortunately medical insurance and rebates are complex. You should be reassured that when Dr Bells secretaries quote your costs using the information you provide there are no tricks or hidden extra charges.
In particular, if your delivery is out of hours, is by caesarean, or is complex and requires extra procedures.... Dr Bell will not charge you extra.
Multiple factors influence your obstetric charge and final out of pocket costs;
▶ Do you have medicare rights. If so medicare rebates and safety net will apply.
▶ Do you have private health insurance, if so is obstetrics covered at the date of your delivery and is the level of your cover 'gapcover'. Although it will not affect our charges, are you covered as a private patient in a private hospital.
▶ Which health fund are you in. In short, the more your fund pays Dr Bell, the less he charges you.
▶ Has Dr Bell managed and delivered any of your previous pregnancies. If so, a discount will apply. The more children he has delivered for you, the greater the discount.
Because of the above, to find your actual charges and your estimated 'out of pocket' please ring the surgery. Our fees are structured so that your pregnancy care with us is both affordable and predictable. At your first antenatal visit we will explain about our fees and their payment in detail. You will know exactly how much you will be 'out of pocket' to us as our patient. You can financially plan for your pregnancy care. Dr Bell is sensitive to all the financial pressures that are present at this stage of your life.
Generally, for over 90% of patients who are privately insured and have medicare rights the charges will be;
First Visit and Scan $185 (Government Rebate $70)
Antenatal Visits at government rebate (ie. no out of pocket)
A variable amount for the 'Retainer Visit' at 20 weeks.
This will be about $3,000
(You will get a Government rebate of about $500, leaving an out of pocket of about $2500).
The exact amount depends on which health fund and the table,
Basically, I try and be as fair as possible. The more I get from a fund, the less I charge you.
If Dr Bell has delivered a child for you then there is a discount. The more children he has delivered for you, the bigger the discount :-)
Delivery (The charge equals your health fund rebate. That is, there is no 'out of pocket')
Post natal visit $75 (Government Rebate $35)
If you 'shop around', it can be hard to compare one obstetrician's fees with another. There is no point being quoted a small "retainer" payment if the antenatal visits incur large out of pocket payments per antenatal visit or 'extras' such as a caesarean section incur extra charges against you. You may wish to enquire if you will see your specialist at each visit. You will see Dr Bell at every antenatal visit.
What if I dont have Private Health Insurance?. If you are not in a health fund, but are covered by Medicare, we can still offer you an affordable package for Dr Bells services. In this case, you would usually elect to deliver at Westmead Public Hospital to reduce costs. Although in a Public Hospital, you would still be unders Dr Bells care.
I am an Overseas Visitor. If you are from overseas and are not covered by Medicare we will tailor a fee package according to your circumstances. This will also take into consideration whether you are covered by an overseas health fund.
Other Fees. When having your baby there will be accounts also from the hospital, other doctors who may be involved in your care (ultrasound doctors, paediatrician, anaesthetist, surgical assistant - if required), and pathology services. These other providors are not under Dr Bells control. Some are provided by the 'on call' service so it can sometimes be difficult to predict the out of pocket accurately.
Payment Methods. We accept for payments cash, EFTPOS, direct debit, Visa and Mastercard.
DOWN SYNDROME AND OTHER ANEUPLOIDY SCREENING
Downs Syndrome (Trisomy 21) is a condition in which a baby carries an extra chromosome. Chromosomes contain the genetic blueprint that regulate growth and development. Babies with Down’s Syndrome have an extra chromosome and this various problems. Children with Downs syndrome are at increased risk of abnormalities of the heart, bowel, hearing, and breathing. They are also at increased risk of developing diabetes and dementia, and intellectual disability of varying degrees. The degree of learning disability cannot be determined prior to birth. It may be profound (10%), severe (70%), or mild (20%). About 45% will survive to the age of 60.
The risk of having a baby with Down’s Syndrome increases with advancing maternal age but women at ANY age can have conceive a baby with Down’s Syndrome. The approximate risk of having a baby with Downs Syndrome is age dependent, set out in the table below;
Age Risk Of Down Syndrome
At Birth At 12 weeks
20 1:1500 1:1000
25 1:1350 1:900
30 1:900 1:600
32 1:660 1:440
34 1:440 1:300
35 1:350 1:240
36 1:280 1:190
37 1:200 1:150
38 1:170 1:110
40 1:100 1:65
42 1:55 1:35
44 1:30 1:20
The risk of having a baby with Downs Syndrome at birth is less than the risk at 12 weeks. This is because a percentage of babies with Downs Syndrome will not make it through the pregnancy. That is, in the absence of a termination, the mother would experience a miscarriage or stillbirth.
Testing may be performed (see below for the options). There would be out of pocket expenses, the amount depending on the test. A few general comments about testing;
There are lots of conditions (eg. Autism) where, at the moment, test results will be normal. That is, we cant check for a "normal" baby, but can check for some chromosome problems.
Testing will not pick up 100% of cases of Down Syndrome. That is, it may suggest that a baby does not have Down’s Syndrome even though the baby does. This is called a false negative finding.
There is a small chance that the test will suggest that your baby has Down syndrome even though it does not. This is called a false positive finding. The NT+ has about a 5% false positive rate, while the cfDNA rate is about 0.1%
If you have a NT+ or cfDNA study that suggests a chromosome problem, then a CVS or amniocentesis will be offered to decide if the result was a true positive (baby has Down Syndrome) or false positive (baby has normal chromosomes). A CVS or amniocentesis (performed at 13-16) weeks has a risk of causing a miscarriage of about 0.5% (1:200).
Whether or not you have testing depends, in the main, on whether you would consider termination if the baby was affected. What do I think?. As long as you are prepared to accept that the tests (NT or cfDNA) study have false positive and false negative findings, I am more than happy to order the test.
If you want to have aneuplody screening, the next step is to decide whether to have an NT+ study or a cfDNA study (there is some controversy as to whether to always have an NT+ as well if you are going to have a cfDNA, but I am not of that view). The quick summary is;
Nuchal Translucency (NT). Zero risk. An ultrasound at 12-14 weeks can be performed by certain specialised ultrasound practices and measures an area of the fluid at the babies neck called the Nuchal Translucency (NT). A thicker than normal NT in combination with an abnormal protein in your blood (PAPP-A) is associated with an increased risk of chromosome problems. In combination with a blood test the NT+ scan can detect 80-90% of cases of Downs Syndrome. It returns a risk ratio. Can vary from 1:2 to about 1:20,000. A positive NT+ study is considered to be either more than 1:300, or at a risk that you judge merits further testing.
Cell free DNA (cfDNA), Fetal free DNA (ffDNA), or Non invasive prenatal testing (NIPT). Zero risk. During pregnancy some of the fetal DNA is released into the mothers circulation. To say that the reliable detetion and analysis of this DNA is complex is a gross understatement. On the one hand it consists of a simple maternal blood test (zero risk), on the other this is an emerging technology. There are a number technologies at the moment; ▶Genesyte (Genea), ▶Materni21 (Healthscope Pathology), ▶Harmony Verify (Douglass Pathology), ▶iGeneScreen (Laverty Pathology). These are changing technologies. Please click on each link above if you may proceed with cfDNA and want to know more about the technology. It involves a maternal blood test at about 10-13w and is about $100 more expensive than the NT+. Takes one week to process. Generally returns either a positive result (about 1:3 chance of Down syndrome) or a negative result (depending on maternal age that ranges from 1:10,000 to 1:150,000).
If you have a positive NT+ study, then either a cfDNA test (for moderate risk) or a CVS-Amniocentesis will be offered.
cfDNA. See above
CVS. Invasive. Performed at 13-14w. 1:200 risk of miscarriage. Rarely needs an amniocentesis if fails. If a termination is decided upon, can be done in theatre.
Amniocentesis. Invasive. Performed at 15w. 1:200 risk of miscarriage. If termination decided upon, usually requires a labour.
CVS and Amniocentesis are invasive procedures, which enable the chromosomes or genetic material of your baby to be examined. These tests have a small risk (about 1:200) of causing miscarriage and will therefore are usually only offered in pregnancies where there appears to be an increased risk of chromosome or genetic abnormalities.
First Visit- Checkup and Dating/Viability Ultrasound. Referral for blood test: Blood count, Hepatitis, HIV, Blood group, Syphillis, Rubella & Urine test.
11-14 weeks- Optional: Cell free DNA or Nuchal Translucency Scan by an outside specialist. If done, High Quality Scans-Strongly Recommended- will attract an out of pocket charge)
13-15 weeks- Optional: CVS or Amniocentesis by outside specialist
16 weeks- Visit
19 weeks- Formal Ultrasound by outside specialist- An anomaly scan. (High Quality Scans-Strongly Recommended- will attract an out of pocket charge)
20 weeks Visit
24 weeks Visit
28 weeks Visit Diabetes Screen
Whooping cough booster for mum (by GP)
Whooping cough booster for caregivers if last booster >10yrs (by GP)
Optional: Antibody Screen (If Rh Negative)
Optional: AntiD shot in Labour Ward (If Rh Negative)
30 weeks Visit
32 weeks Visit
34 weeks Visit Optional: AntiD shot in Labour Ward (If Rh Negative)
36 weeks Visit Start weekly visits. Group B Streptococcus (GBS) vaginal swab
There is flexibility to the above depending on how many pregnancies you have already had and other factors which may increase or decrease your risk of complications.
Following these guidelines can greatly reduce your chances of contracting Listeriosis.
Eat hard cheeses instead of soft cheeses. Hard cheeses such as cheddar and semi-soft cheeses such as mozzarella are safe to consume. Pasteurized processed cheese slices and spreads such as cream cheese and cottage cheese can also be safely consumed. The most important thing to do is to read the labels!Pregnant women should avoid soft cheeses such as feta, Brie, Ricotta, Camembert, blue-veined cheeses and Mexican style cheeses.
Do not consume unpasteurized dairy products (eg. Raw goats milk)
Avoid cold meats. Either ready to eat from deli counters and sandwich bars, or packaged sliced ready to eat cold meats. Do not eat hot dogs, luncheon meats or deli meats unless they are properly reheated: Eating out at certain restaurants that provide deli meat sandwiches such as Subway is not recommended for pregnant women since they do not reheat their deli meats.
Do not eat cold cooked chicken.
Do not eat refrigerated pates or meat spreads.
Do not eat pre-prepared or pre-packaged salads (eg. Salad bars or smorgasbords)
Do not eat smoked seafood unless it is contained in a cooked dish, such as a casserole.
Do not eat chilled seafood. This includes raw (oysters, sashimi, sushi), smoked, or ready to eat prawns (includes prawn cocktails, sandwich fillings, and prawn cocktails).
Practice safe food handling:
Wash all fruits and vegetables
Keep everything clean including your hands and surfaces
Keep your refrigerator thermometer at 40 degrees or below
Clean your refrigerator often
Avoid cross contamination between raw and uncooked foods (this includes hot dog juices)
Cook foods at proper temperatures (360 degrees is the recommended temperature for most food items and you can use a food thermometer to read the temperature)
Refrigerate or freeze promptly