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Fees: Special Care Nursery

When a baby is admitted to Special Care, the billing arrangement changes. Medicare and your private health fund may both contribute, depending on your policy.

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Admission to SCN changes the billing arrangement

Once your baby is admitted to the Special Care Nursery they are a hospital inpatient. How the admission is billed depends on its length: the practice arranges the appropriate route — there is nothing for families to choose or request.

The Extended Medicare Safety Net does not apply to SCN claims — Safety Net excludes hospital inpatient services. For eligible policies, the private fund may cover some or all of the remaining gap, typically through theEclipse claiming channel.

What is Eclipse?

For longer admissions (typically beyond about a week), billing moves to Eclipse — the joint Medicare + private-fund claiming channel for admitted inpatients. Under Eclipse:

  • The paediatrician’s fee for each item is split between Medicare and your fund.
  • Medicare pays its standard rebate; the fund covers the remaining gap up to a fund-specified amount, depending on your policy.
  • You see a single capped known-gap on the invoice — commonly around $500 for the whole admission — or no gap at all, depending on your fund and policy.
  • The line-item MBS fees that Medicare and the fund are netting out behind the scenes aren’t visible to you. You don’t see a day-by-day bill.

How your admission is billed

The practice arranges the billing route based on the length and nature of the admission — there is nothing for you to choose or request.

Longer admissions (7+ days)

Longer admissions — typically beyond about a week — are billed through your health fund via the Eclipse channel.

Out-of-pocket commonly capped around $500 for the whole admission — indicative only; the exact figure depends on your fund, your policy and the admission itself.

Brief SCN stays

Shorter Special Care admissions are billed like the rest of the stay — the standard items and Medicare rebates shown on the in-hospital fees page.

The total simply reflects the attendances your baby needed, exactly as on the postnatal ward.

What to do

  • If your baby is admitted to SCN — the ward will let us know, and a different consent / registration step starts. You don’t need to initiate this; we will.
  • If you have questions about the billing — call our rooms on (03) 9007 2099 and we’ll explain how your baby’s admission is being billed.
  • To check your fund cover — ring your private health fund and ask “Do you offer no-gap or known-gap arrangements for inpatient paediatric services?” The answer varies by fund and by policy tier.

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