Australian rural healthcare and a broke pregnant American girl ...
September 15, 2012 10:05 PM   Subscribe

My sister-in-law is somewhere in NSW, Australia, pregnant, and a US citizen ... are we supposed to be freaking out? Links to pages of how a US citizen gets healthcare in AUS appreciated.

So, my sister-in-law is pregnant, with what we are reasonably safe to assume to be a high risk-pregnancy. She recently dropped everything in the US to move across the world to Australia and live with a guy she met online. And she's happy, so good for her.

However, from what we ... and her ... understand about the Australian healthcare system, the girl that spent all of her money to get to Aus and move in with a guy in a very rural part of the country should come back to the US to deal with the possible complications of pregnancy.

Is there a way for her to get cheap or free pre-natal care in Australia ... or does she need to come back, like the rest of us insist?

Wish I knew more, but the extent of my Australian knowledge consists of one night in a bar in Seoul, when a bunch of Aussie soldiers showed us what the word 'drinking' really meant ...
posted by Risingfenix to Health & Fitness (27 answers total) 1 user marked this as a favorite
I'm Australian and I'm pretty sure (but not positive!) that you have to be a citizen to qualify for Medicare or have your own travel insurance that would cover it. If she googles Medicare Australia it will probably cover the finer points. There might be a loophole if she can prove she's defacto to an Australian but I wouldn't bank on it.
posted by Jubey at 10:17 PM on September 15, 2012

I think we need more information. What is her status in Australia, visa-wise? It's hard to answer without knowing that... for example, depending on her circumstances, she might be able to get Medicare eligibility by having the length of relationship requirement for a partner visa waived on compassionate grounds. They do that sometimes if there's children to a relationship, so it might be worth finding out if they'll do it for a pregnancy if your SIL is truly broke.
posted by lwb at 10:20 PM on September 15, 2012

It's a tourist visa (class 676), that was a three-month visa, now extended to 6 months ...
posted by Risingfenix at 10:28 PM on September 15, 2012

Just to add, if she's a permanent resident I think she qualifies. If she's on a working or student visa I think the answer is no. Australians pay massive amounts of tax and a hefty chunk is to cover Medicare so they're pretty careful about who accesses it, understandably. If she has Medicare card, she's good. If not, she'll be asked to pay upfront. Best of luck to her with the pregnancy. I'm glad she appears to have healthcare options in the States.
posted by Jubey at 10:29 PM on September 15, 2012

Just read your update. It doesn't look good for her as a tourist. Sadly, if it were that easy, everyone would come here and get free healthcare.
posted by Jubey at 10:31 PM on September 15, 2012

Well, yes, the thought did cross my mind ... :)

I figured that would be the answer, just wanted to make sure before we tell it to her, repeatedly ...

Thank you for the help. :)
posted by Risingfenix at 10:33 PM on September 15, 2012

Yeah, moving to another country on a tourist visa is generally not the greatest idea.

Is the partner willing to marry her? My understanding is that the married partner visa doesn't have the same 12-month relationship requirement that the de facto one does, though they'll still need to prove it's a genuine relationship...
posted by lwb at 10:34 PM on September 15, 2012

They are engaged, so I would assume that may be a possibility. I'm not really sure how serious, or how motivated, either one them are at this point, though.

While the threat of thousands of dollars of medical bills are quite scary to any of us who have had thousands of dollars of medical bills, the reality is usually lost on those who haven't had the same experience.

Which is why we're telling her to come back home.
posted by Risingfenix at 10:42 PM on September 15, 2012

I work in Australian healthcare and I can guarantee that she's not covered unless she's got travellers insurance. Even then, it's mostly enough cover to get you back to your own country and not long term (ie pregnancy) type care.
posted by Silentgoldfish at 10:44 PM on September 15, 2012 [1 favorite]

She won't be eligible for medicare on a tourist visa. Could she buy private health insurance? I am an American working in Australia- as condition of my visa (employment, non-permanent resident) I have to purchase my own private health care. It's around $90 a month, which is a huge bargain compared to the prices in the US. She should look into what sort of private insurance she should get now to end up with the lowest out-of-pocket expenses for prenatal care and delivery costs.
posted by emd3737 at 11:09 PM on September 15, 2012 [6 favorites]

Does she have U.S. insurance already? If she's coming back to the U.S. and hoping to buy individual insurance, insurers aren't required to cover pregnancy on individual policies until 2014. Usually you have to buy a rider and be on the plan for a year before pregnancy is covered.

Some states (like California) already require individual plans to cover pregnancy, but most do not.

Unless she's carrying U.S. insurance right now and hasn't let it lapse, or has a job through which she qualifies for group insurance, she may be equally SOL in the U.S.
posted by Eyebrows McGee at 11:20 PM on September 15, 2012 [1 favorite]

Here the relevant page on the Department of Immigration website. If she is on a 676 visa, she's not covered by Medicare. But there are Australian insurance companies that offer insurance for overseas visitors that might be helpful. She should call one and see if she can get a policy sorted out. Australian private health insurance is far, far more affordable than US insurance, from what I understand.
posted by His thoughts were red thoughts at 11:58 PM on September 15, 2012 [1 favorite]

My insurance (as a Canadian living in Australia on a working visa) clearly states in several sections that pregnancy is not covered in the first year of insurance coverage. This seemed to be a standard clause across several insurance companies. So that option is probably out as well...
posted by third word on a random page at 12:11 AM on September 16, 2012

On the other hand, if she's not covered by US insurance and is looking at paying for everything herself, I'm almost certain that whatever medical assistance she needs will cost less here than back in the US.
posted by flabdablet at 1:08 AM on September 16, 2012 [4 favorites]

What everyone above says about not being able to access Medicare and about private insurance not covering pregnancy at least for the first year is correct.

However, I was not insured and not covered by Medicare in Australia for the first three years of my time here. I paid everything out of pocket. The expenses are nowhere near what they are for uninsured people in America. A doctor's visit (GP) will cost around $80. A specialist visit between $150 and $200. An ultrasound again around $200-300. A hospital stay will be pricier, but it still might be worth looking into if she is uninsured back in the USA.
posted by lollusc at 1:11 AM on September 16, 2012 [4 favorites]

(I did once try to figure out what an uninsured pregnancy would cost me here, including a hospital birth and a few days stay, and it worked out in the tens of thousands, not hundreds of thousands.)
posted by lollusc at 1:12 AM on September 16, 2012

That's still a lot I think - it's about 400 bucks a night for a standard hospital bed, 2000 a night for ICU and that's not including tests and meds.
posted by Silentgoldfish at 1:22 AM on September 16, 2012

Just brainstorming here, but in Australia I've noticed random small newspaper ads with headlines like, 'Pregnant? Scared? Call xxxxx we can help' They always struck me as being some Christian support group (just guessing) looking to help young women who would otherwise abort to get help. It's a long shot, but maybe she could try them?
posted by Jubey at 2:32 AM on September 16, 2012

I have a friend who is a nurse who works at a big hospital in Brisbane and she says they have a lot of overseas students come in to deliver their baby for free. Although they are meant to pay for the service, and sign forms to say that they will, the problem is many of them go home not long after without paying. The hospital tries to recover the money but doing so is difficult.

Do with that information as you will...
posted by Effigy2000 at 4:15 AM on September 16, 2012 [1 favorite]

Where is she exactly? Medicare and citizenship is a federal issue, but hospitals and insurance are state based. Its also not much help identifying cheap sources of medical care in Broken Hill if she's in Boondalup.

If your friend is rural, then she qualifies for migration advice through the Immigration Advice and Application Assistance Scheme. They may be the best people to speak to about whether a spousal visa is a viable option (the process is very long, and if she needs medical care now, it may not be)

This pamphlet by NIB suggests that the average out of pocket expense for a birth in Australia is $2,445 -$8,355. But that's for a best case scenario with no complications.

As she's rural, she also needs to take into account the possibility that she will need to be airlifted to a larger hospital. Ambulance coverage is quite affordable, and will cover air transport.

(Also, I'm only mentioning this because you've marked Jubey's response above as best answer, and might be using it as the basis for assumptions about how expensive health care is in Australia- the average Australian personal tax is comparable to the average US personal tax, coming out as lower in some sources I've seen, and only 1.5% of annual income is paid towards Medicare.)
posted by PercyByssheShelley at 4:34 AM on September 16, 2012

I'm almost certain that if she doesn't have insurance in the US, paying for the birth in Australia will be cheaper.

In England, which is what I know very well, delivery without complications is £3000 and the scans/outpatient appointments under £100 each. These are NHS tariffs, but utterly invisible to the patient. The hospital must adopt a treat first, invoice later policy to pregnant women from overseas, too.

But if she were to leave for the US without having paid the bill, like effigy2000 says, it may well not follow her, or at least be in abeyance until her next visa application.
posted by ambrosen at 4:52 AM on September 16, 2012

I have a friend who is a nurse who works at a big hospital in Brisbane and she says they have a lot of overseas students come in to deliver their baby for free. Although they are meant to pay for the service, and sign forms to say that they will, the problem is many of them go home not long after without paying. The hospital tries to recover the money but doing so is difficult.

I wouldn't rely on this at all - my hospital changed it's policies at the start of the year because we kept getting taken advantage of like this and now it's 400 dollars upfront if you don't have a medicare card, unless you're requiring CPR. You're then charged for any procedures on top of this, and they've gotten a lot more aggressive about collecting. If you have insurance you can claim all of it back but you're still out of pocket to start with.

I'd be very surprised if other hospitals aren't following suit, especially with the current govt in Qld insisting on all sorts of ridiculous public sector budget cuts.
posted by Silentgoldfish at 4:59 AM on September 16, 2012

the process is very long, and if she needs medical care now, it may not be

This is true, but this suggests that she may be eligible once she's applied for a permanent visa, although I don't know what the other criteria that need to be met are.

Really I think the bigger issue is where she's going to have the most support after the baby's born, because it sounds like she doesn't have a lot of it here in Australia.
posted by lwb at 5:00 AM on September 16, 2012

I'm not sure why you assume the pregnancy will be high-risk if she hasn't yet accessed medical care...? Does she have a chronic ongoing condition like diabetes? If not, the pregnancy might not be high-risk or require extra medical care. Obesity, for example, doesn't always require extra cost and isn't considered high-risk for everyone.

From what lollusc said, it might be much cheaper to give birth in Australia if she's paying out of pocket. Also, the baby's father is an Australian citizen so the baby would be an Australian citizen from birth, making post-natal medical care MUCH more affordable than it would be in the US. Even with insurance, we had to pay $500 for a one-night hospital stay with my son due to an illness after birth. It would have been more like $6,000 if we'd paid out of pocket.

Additionally, my understanding of their benefit system is that the parents receive $5000 in a baby bonus after the birth in installments. Obviously, Americans don't receive that.

Compared to the cost of returning to the US (flights, which she'll want to fly as soon as possible especially if she's high risk which will mean $$$), the cost of pediatric care in the US, the difficulty of establishing paternity and gaining the child Australian citizenship and child support...staying in Australia might be cost-neutral or cheaper.

Your spouse's family "insisting" that she return to the US is understandable--I'm sure you're nervous and WTF-ing about her moving overseas and getting pregnant to someone she met online--but it might not be the best thing for her or her child financially or even emotionally, if she wants to stay with the baby's father.

Also, she is an adult, and trying to insist that she do something might backfire and make her unwilling to share information. It might be better to take a big step back from trying to convince her of anything and just listen and be there for her unless and until she asks for help.

Good luck to you and your family.
posted by the young rope-rider at 10:02 AM on September 16, 2012 [6 favorites]

Have her go to the local doctors and talk to them, rural doctors and nurses are very helpful and may be able to suggest places to contact for information. If she is in the process of applying for permanent residence she may be eligible for Medicare.

She should contact one of the many immigrant service and support groups, even if it's just by phone they will be able to give her a much clearer idea of what she is eligible for and will have seen situations like this before and have a much clearer idea of what to do. If nothing else it will give her people in the country that are there to help her.
posted by wwax at 10:16 AM on September 16, 2012

[Folks, please stick to the question as asked. Thanks. ]
posted by restless_nomad at 2:46 PM on September 16, 2012

You haven't mention where in NSW she is. But many places have migrant support services. Here's the one for Orange, which is a major NSW regional centre.
posted by His thoughts were red thoughts at 6:18 PM on September 16, 2012

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