What is bulk billing and how does it work?

When it comes to managing the household’s finances, the cost of medical care can be a concern for some families. In Australia, we have the Medicare system, which is designed to make affordable healthcare more accessible to everyday Australians. As well as the services and rebates available through Medicare, some practitioners also “bulk bill” – which may mean your appointment won’t cost you anything.

What is bulk billing for medical procedures?

Bulk billing is the term used in Australia to refer to healthcare services that are provided at no cost to the patient. Rather than paying a fee for your visit and then seeking a partial rebate through Medicare, your medical practitioner will bill Medicare directly, leaving you with no out-of-pocket expenses.

You may need to press a button on an EFTPOS machine or sign a form, to give your permission for the practice to seek payment from Medicare on your behalf. If you are unable to sign – for example, if you are underage, unconscious or injured – another person such as a family member may be able to give consent on your behalf.

Who is eligible for bulk billing?

Bulk billing is offered at the discretion of the individual doctor or medical practice, but first and foremost, to be eligible for bulk billing you must be enrolled in Medicare. If you are unsure whether you are eligible, it could be a good idea to ask the medical practice before your appointment, to help you determine whether you’re eligible for bulk billing. The Department of Human Services also provides instructions on how to enrol in Medicare and get a Medicare card.

Some doctors may have a policy where they bulk bill certain patients, such as Age Pension recipients or Seniors Card holders, while others may include Health Care Card holders, students and children aged under 16 years. Some may also choose to bulk bill patients for follow-up appointments where they receive test results.

Certain medical centres may offer to bulk bill all patients, regardless of their age or income, and some services that operate after regular business hours and offer home visits also bulk bill.

Bulk billing is quite widespread amongst general practitioners (GPs) – according to the Department of Health, 86.2% of all services conducted by GPs are bulk billed every year. However, a 2018 report by the Royal Australian College of General Practitioners (RACGP) estimated only 23% of GPs offered bulk billing to all patients.

People who may be eligible for bulk billing

  • Age Pension pensioners
  • Seniors Card holders
  • Health Care Card holders
  • Students and children
  • Children under 16 years of age
  • After hours/home visit services
  • All patients at a designated bulk billing practice

How does bulk billing work?

After your consultation with the doctor, the receptionist will ask you to consent to having your visit bulk billed. The practice then lodges a claim with Medicare. In this scenario, you typically won’t need to pay anything upfront, or claim back any costs from Medicare – the fee for the entire visit is handled between the medical practice and Medicare directly.

What services can be bulk billed?

Most often, bulk billing applies to visits to a general practitioner (GPs) and some specialist procedures, as well as certain pathology tests, scans and eye tests. For instance, it may apply for:

  • visits to your GP for routine appointments
  • visits to specialists who offer bulk billing
  • tests and scans, such as x-rays and pathology tests
  • eye tests performed by optometrists

It is not generally applicable to inpatient services at a hospital.

Cost of Bulk Billing
Source: Monkey Business Images (Shutterstock)

It’s also important to note that there are limits on the number of services that can be bulk billed in a single visit. If you receive more than one service on the same day, you may not be able to be bulk billed for all of them, according to Human Services, so always ask your practitioner or their administration staff beforehand.

Can you request a bulk-billed consult at any clinic?

You can always ask your practitioner in advance if they could bulk bill your appointment or service or ask for a discount – but be prepared for the possibility that the practitioner may decline your request.

Be sure to advise your doctor or medical practice if you hold a concession or pension card, as they may offer discounted rates for certain patients, even if they don’t typically bulk bill. It’s generally advisable to clarify your out-of-pocket costs before you attend the appointment if you want to avoid receiving an unexpected bill for the service.

What are “gap fees” and when do they need to be paid?

The term “gap fee” refers to the difference between the amount the doctor charges, and the rebate that is paid by Medicare. This is also known as your out-of-pocket amount and it is applicable to any consultation that does not attract bulk billing.

Medicare rebates are calculated according to the Medicare Fee Schedule set by the Federal Government. The doctor or medical centre is free to set their own prices for different procedures or consultation types, which means the “gap fee” can vary widely between clinics.

For example, the Department of Health explains that a standard consultation at a GP is usually billed as an “Item 23, Level B”, which is used for a consultation lasting less than 20 minutes. The Medicare rebate as at November 2019 for this item is $38.20. If your doctor charges $75.00 for this appointment, your “gap fee” will be $36.80.

bulk billing paying fee
Source: Pixel-Shot (Shutterstock)

If your consultation is not bulk billed, you will usually need to pay the entire fee on the day of your consultation. If you have registered your bank details with Medicare and ask the practice to claim on your behalf, you should receive the Medicare rebate back into your bank account within a few days.

Alternatively, you can ask the receptionist for a receipt, which you may then use to claim back the rebate – either by attending a MyGov office, or by using Medicare’s online, mobile app or mail claim options.

If you visit your doctor regularly, you may be able to make use of the Medicare Safety Net, which could reduce your gap fee even further.

Where can you find a bulk billing doctor?

The government website Health Direct offers a search function you can use to find a doctor, hospital or allied health provider. This service allows you to narrow your search results to practitioners who bulk bill, as well as entering your postcode so you can find clinics close by. If there is a particular medical practitioner you are planning to visit, you can also telephone them to ask if they bulk bill. Remember to let them know if you hold any concession cards.

If you’re comparing health insurance policies, the table below displays a snapshot of a hospital and extras policies currently available on Canstar’s database for a single female born in 1985 seeking cover in NSW without pregnancy cover. Please note the table is sorted by Star Rating (highest to lowest), followed by monthly premium (lowest to highest) and features links direct to the provider’s website. Use Canstar’s health insurance comparison selector to view a wide range of policies.


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About Sarah Megginson
A finance and real estate journalist for more than a decade, Sarah Megginson has been the editor of Your Investment Property magazine since 2016. She is also an opinion columnist, a freelance writer, and an editor who has penned 20+ books. She has three young children and is an ambassador for Act for Kids.
Main image source: Monkey Business Images (Shutterstock)
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