What is bulk billing and how does it work?

What is bulk billing and what does it actually mean? We explain in depth how bulk billing works in Australia.

What is bulk billing?

Bulk billing refers to healthcare services provided at no cost to patients in Australia. Instead of paying a fee and seeking a partial rebate through Medicare, your medical practitioner will bill Medicare directly for your visit, leaving you with no out-of-pocket expenses. The bulk-billing practice then accepts the Medicare benefit as the full payment for the service.

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. Services Australia says bulk billing can cover:

• visits to GPs and specialists that bulk bill
• tests and scans like x-rays and pathology tests
• eye tests performed by optometrists

How does bulk billing work?

For patients:

When you go to a bulk-billing medical practice, you won’t need to pay for your treatment. You may be asked to sign a document, or press a button on an EFTPOS machine, to show that you have given consent for the practice to claim the service from Medicare.

For the medical practice:

After the patient has given consent, and after the consultation has taken place, the practice sends an electronic claim to Medicare on the patient’s behalf. Medicare then pays the practice for the consultation. The practice needs to specify the MBS codes that apply to the treatment.

Do all doctors bulk bill?

Not all medical practices bulk bill patients, so it’s a good idea to familiarise yourself with the practice’s policies. For example, some practices may bulk bill everyone, while others may only do so for people under or over a certain age, or for certain conditions. There may also be some services where bulk billing does not apply at all. In these cases, patients are charged a higher fee than the bulk-billing fee. Those patients are required to pay in full upfront, and then claim part of their costs back from Medicare. You can ask for fee information from the practice, and even request a quote for the expected cost of your visit.

It is also a legal requirement that medical practices receive your permission for them to seek payment from Medicare on your behalf. If you are unable to give consent – for example, if you are underage, unconscious or injured – another person, such as a family member or power of attorney, may be able to do this on your behalf.

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

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

Be sure to let your GP or their receptionist know if you hold a concession or pension card, as discounted rates might apply for certain patients. Finding out if a medical practitioner bulk bills beforehand may be a good idea too.

How to find a bulk billing doctor?

If you’re looking for a bulk billing GP, calling practices near you and asking directly can be one easy way to find a bulk billing clinic. By calling, you are also able to find out if there will be any potential gap payments for the medical services you’re seeking.

Otherwise, you can also search online. Healthdirect Australia, the national virtual public health information service, has a ‘Find a GP’ search tool that allows you to filter the results to only show bulk billing GPs in your area. This tool uses the National Health Services Directory (NHSD), a national directory of health services and practitioners in Australia. There are also other online healthcare directories, such as Cleanbill, that you can use to search for local bulk-billing doctors.

If you have any doubts, you can always ask directly before making an appointment on whether the services will be bulk billed or if there’ll be any gap payment for your visit.

Why has my doctor stopped bulk billing?

With the rise of inflation and the Medicare GP rebate going up no more than $5 in the past 12 years, doctors are opting to charge an out-of-pocket fee instead of relying purely on the Medicare rebate.

The Medicare quarterly statistics backs this up, showing the number of doctors who bulk bill dropping rapidly, with the latest statistics release showing another decline to the bulk billing rate at 80.5%, the lowests it’s been since the 2011 June Quarter. But these numbers are likely an underestimate, a belief held by most analysts, according to the Sydney Morning Herald. Figures from Cleanbill’s National General Practitioner Listings Report seem to support these reservations, with the report revealing only 42.7% of the surveyed GP clinics bulk billed.

Confusing billing practices are likely a confounding factor affecting the official statistics. Clinics that claim a Medicare rebate but also charge patients an out-of-pocket fee will show up as having bulk billed, which is obviously not the case in reality.

Are there limits to bulk billing?

Yes, and this depends on the policy of the medical practice as well as the rules of the MBS. For example, if you have more than one service in a visit, you may not necessarily be bulk billed for everything. In this case, you’ll receive a patient account and will need to cover the bill. The difference between the total account and your Medicare benefit is called a ‘gap payment’.

Whether this limit applies will depend on the medical service or health professional you’re seeing. You can always ask the practice beforehand if you’re unsure a gap payment will apply for your visit.

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