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 for your visit directly, leaving you with no out-of-pocket expenses.
To be eligible for bulk billing, you must be enrolled in Medicare. Services Australia has information about how to enrol in Medicare and get a Medicare card. You may also need to give your permission for a medical practice 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 may be able to do this on your behalf.
Who is eligible for bulk billing?
Some medical practices 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. Depending on the medical practice, the following groups may be among those eligible for bulk billing:
- all patients who use a bulk billing medical practice
- children under 16 years of age
- clients accessing after-hours or home visit services
- Health Care Card holders
- Seniors Card holders
- students and children
What doctors bulk bill?
It is at the discretion of providers whether they offer bulk billing or not, so you may like to check with a medical practice before making an appointment. Some medical providers offer bulk billing for some clients, but not others, so explaining your situation to them with a phone call beforehand may be a good idea to clarify if you are eligible. Let them know too if you have any concession cards. You can search for a doctor that bulk bills using the Australian Government’s healthdirect website, and narrow the results to your local area.
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. 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
It is not generally applicable to inpatient services at a hospital.
Are there limits to bulk billing?
Yes, 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’.
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.
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.
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.
If you’re comparing health insurance policies, the table below displays some of the 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 provider name (alphabetical) and features links direct to the providers’ websites. Use Canstar’s health insurance comparison selector to view a wide range of policies.
Original reporting by Sarah Megginson.