How do I know my test will be bulk billed so I am not charged out of pocket fees?
The following requirements must be met in order for your test to be bulk billed:
- a valid Medicare number
- tests requested are Medicare rebateable
- the doctor has clearly indicated to bulk bill on the request and all Medicare requirements are clearly stated against the test’s requested, and
- you have signed the Medicare Assignment.
If these requirements have not been met, then you may receive a bill for out-of-pocket expenses. Your collector will provide a brochure for your convenience.
What tests are not covered by Medicare?
Mater Pathology has a small number of tests which are requested by physicians that are not eligible for Medicare rebates. We offer market competitive rates for these tests to limit the impact to you. View our non-Medicare rebateable test schedule.
If I am a private inpatient, will I receive a bill from Mater Pathology?
The majority of patients covered by private health insurance do not pay out of pocket fees.
You may receive a bill for the following reasons:
- Mater Pathology has signed agreements with all private health providers for ease of payment. If you are admitted using your private health insurance, we will forward all accounts directly to your insurer. The only time you will receive a direct account from Mater Pathology is if we do not have an agreement with your private health insurer, this is however extremely rare. Please check with your insurer if in doubt. There are a small number of tests which are not covered by Medicare (non-Medicare rebateable tests) which will incur an out of pocket cost. This bill will be sent to you.
- If you are a self-insured private patient (without private health insurance) you are responsible for your account. Once the account is paid, we will send out a receipt that will enable you to claim your rebate from Medicare (estimated to be 75% of scheduled fee).
- Overseas patients will be asked to pay for all services upfront. If you have travel or overseas health insurance you will be able to forward your paid account to your insurer for reimbursement.
Who can I contact about my bill?
For all account enquiries please call 07 3163 8636 Monday to Friday 8 am – 4.00 pm.
Mater Pathology endeavours to limit all out of pocket expenses to you. For private pathology tests, we bulk bill all accounts directly to Medicare. If you hold the following cards or meet relevant criteria, you will not receive any additional expenses for routine tests upon presentation of the relevant card or information (work cover):
Overseas patients can utilise our services—we ask our overseas patients to pay for the services they are utilising upon presentation. Once a receipt for these services is provided to you, you are able to claim from the relevant travel or health insurer.
Mater Pathology has ‘No-Gaps Agreements’ with private health funds and these arrangements may change over time. If you are insured with these funds, your account for Medicare eligible tests performed while you are in hospital will be sent to your health fund for full payment. Before attending, please check with your insurer for further details.
Uninsured patients will receive an account for their Medicare eligible tests. Once the account is paid, we will forward your receipt to enable you to lodge a claim with Medicare and obtain your rebate for eligible tests.
If you are a self-insured private patient you are responsible for your account. Once the account is paid, we will send you out a receipt to enable you to lodge a claim with Medicare and obtain your rebate for eligible tests.
Mater Pathology bulk bills all community tests which are eligible for a Medicare rebate. To be eligible for a Medicare rebate, the following requirements must be met:
- a valid Medicare number
- tests requested are Medicare rebateable
- the doctor has clearly indicated to bulk bill on the request and all Medicare requirements are clearly stated against the tests requested, and
- you have signed the Medicare Assignment.
If these requirements have not been met then you may receive a bill. Your collector will provide a brochure for your convenience.
A small number of pathology tests are not eligible for a Medicare rebate or may only be eligible for a Medicare rebate when the patient satisfies certain conditions. The Department of Health and Ageing is responsible for administering the Medicare Benefits Schedule that specifies which tests are eligible for a rebate. If you have non-Medicare rebateable tests performed you will receive an account, even if other tests are bulk billed or direct billed to your health fund.
Additionally, Mater Pathology bulk bills routine Medicare eligible pathology tests for the following patients:
- Pension (PHB) cardholders
- Health Care cardholders
- Veterans Affairs Gold cardholders
- Commonwealth Seniors cardholders
- Nursing home residents
Tests requested in any of the following circumstances are not eligible for a Medicare rebate: employment and education health screening, immigration, insurance, overseas patients, superannuation, travel, visa applications. Additionally, please see our current price list for common tests ineligible for a Medicare rebate.
If the referral is related to a Workcover or Transport Accident Commission claim and a claim number is provided, an account will be forwarded to the organisation for payment. If a claim number is not provided, you will receive an account.
Except for Non-Invasive Prenatal Testing (NIPT), public patients of Mater hospitals do not incur out of pocket pathology expenses provided testing is performed by Mater Pathology. In some outpatient circumstances, the cost of eligible testing may be charged directly to Medicare.
Public patients that elect to have NIPT will be charged the cost of the test up front to enable testing to proceed.