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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, and the billing arrangement changes — Medicare and your private health fund may both contribute, usually through the Eclipse claiming channel.

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?

Eclipse is 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.

When Eclipse may be suitable

Stays of 7+ days

SCN stays of more than a week, where day-by-day billing has accumulated past a few hundred dollars in gap.

Out-of-pocket commonly capped around $500 for the whole admission, depending on fund and policy.

Brief SCN stays

For brief SCN admissions (a few days) the trade-off is fund- and policy-specific. We discuss whether Eclipse is the right route for your situation at the time.

For a short admission, day-by-day billing with the standard Medicare rebate can work out cheaper than the Eclipse known-gap, depending on your fund. Worth a call before deciding.

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 length of stay is uncertain — call our rooms on (03) 9007 2099 and we’ll talk you through whether Eclipse is the right route for your fund and policy.
  • 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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