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Fees: Special Care Nursery

A baby admitted to Special Care is a hospital inpatient. If your baby is covered by your private health policy, Medicare and your fund both pay towards the paediatric fees, but a gap may apply.

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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, whatever the length of the stay. Medicare pays 75% of the schedule fee for each item, and your health fund pays the other 25% if your baby is covered by your policy. A gap may apply where fees are above the schedule fee.

The Medicare Safety Net does not apply to SCN stays: it covers out-of-hospital services only, and a baby in Special Care is an inpatient.

What is Eclipse?

Eclipse is the electronic system for sending hospital inpatient claims to Medicare and your health fund together. For longer admissions (typically beyond about a week), the practice bills through your fund’s gap-cover arrangement using Eclipse:

  • Medicare and your fund pay their share of each item directly.
  • If your fund takes part and your baby is covered by your policy, your gap for the whole admission is limited to $500.
  • Your invoice shows the gap for the whole admission rather than a day-by-day bill. The rooms can explain the items behind it.

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)

Billed through your health fund’s gap-cover arrangement, with claims sent to Medicare and your fund together through Eclipse.

If your fund takes part and your baby is covered by your policy, your gap for the whole admission is limited to $500.

Brief SCN stays

Each attendance is billed as an inpatient item: Medicare pays 75% of the schedule fee and your fund the remaining 25% if your baby is covered. A gap may apply, and the Medicare Safety Net does not apply.

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: confirm your baby is (or will be) on your policy, 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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