Independent midwives have practice numbers issued by the board of health care funders, which means that you are able to claim their fees back from your medical aid. It is important to remember though, that even though we as midwives have practice numbers, it does not mean we charge medical aid tariffs. Most Independent midwives charge above medical aid tariffs for services rendered.
How much of the midwives fees get refunded to you solely depends on what medical plan you are on and what percentage in relation to medical aid tariff your medical aid plan covers. You will need to contact your medical aid and provide them with the necessary codes and practice numbers. It is important to remember though that some hospitals have private room fees that are over and above the general facility fees. It once again depends on which plan you are on, as to whether this will be covered by your medical aid and you might need to pay that in cash.
When should I get authorisation and what do I need to do the authorisation?
Your medical aid generally would expect you to get authorisation for the birth before you are 28 weeks pregnant.
When doing the authorisation with them you will need the following:
- The practice number for the hospital you are birthing at.
- The practice number for your midwife and/or your Gynaecologist/Obstetrician. It is very important to specify to the medical aid (if birthing with a midwife) that your midwife is your main care provider and that the doctor is your backup in case of emergency.
- You will also need ICD 10 codes and procedure codes for the birth itself (these will be given to you by your midwife, but there is also a code that you need to get from the hospital).
I am not on a medical aid and pregnant, what should I do?
- Most Independent Midwives will take cash upfront and you will have to enquire with the Independent Midwife of your choice about their rates and packages.
- If you join a medical aid after you are aware that you are pregnant already they will exclude the pregnancy from being covered. The important thing is that your baby will be covered immediately after birth if you do inform the medical aid that you are pregnant and wish for the baby to be on the medical aid after the birth.
- This will help you a lot in terms of finances if your baby needs to go to ICU for instance. Remember that ICU stays are very costly and most private ICU facilities would ask for a deposit of +/- R150 000 for babies not on medical aids before they will even admit your baby.
- It is also not very easy to get ICU beds for babies in the government/ public sector as they are under resourced and have limited ICU beds available. So we mostly find it easier to transfer babies to private hospitals.
- The best way to go forward in regards to joining the medical aid is for you or your spouse to join as a main member and to state that baby should be registered as a member immediately after birth. If you want the medical aid only for the baby, it means that the baby will only be registered after the birth in which case the medical aid would very likely apply certain waiting periods (exclusions) for a certain period of time. These restrictions could include things like ICU admissions. This will then actually defeat the purpose of joining the medical aid in the first place.
I have a medical insurance. Is this good enough?
- Generally most private hospitals will accept a medical insurance. It is however important to remember that they will only pay the hospital fees and you would have to pay your midwife/ doctor’s fees out of pocket. You will need to enquire with the hospital of your choice.
- It is also very important to read the fine print on your contract with the medical insurance company as they usually have clauses there that would for instance say that they will only pay the hospital if you were admitted for more than 24 hours, or 48 hours etc. This same clause might also apply to an ICU admission for a baby.
- Having a baby is a joyous time in your life, and it is important to financially plan for this major event in your life. It is thus important that you are well prepared when making your choices and also that you are well informed on what you can expect in terms of costs.