Overseas visitors are sometimes covered by Medicare. If this applies to you, your billing will be handled in the same way as for any other Australian resident. You may be covered by travel insurance or some other insurance. It would be best to contact your insurer for further instructions regarding what you should do about medical fees. In general, you will need to pay your fees in full on the day, and seek reimbursement from your insurer later. Some insurers will need to pre-approve your medical treatment before agreeing to any reimbursement for your medical costs. If none of the above apply to you, you will be asked to pay your fees prior to your consultation.
Any medical services performed after the referral has expired will not be reimbursed by Medicare, and you will be liable for the full cost. A referral cannot be “post-dated”, meaning it cannot be issued on a date after which the actual medical service has occurred. This practice is illegal. If you do not have a valid referral, and a referral letter is required for your Medicare or insurance reimbursement, you will need to obtain one prior to your medical consultation or test. Our reception staff will remind you if a new referral is required.
A referral is a document which serves two purposes. It contains information regarding a patient’s condition, with directions for the patient’s doctor regarding treatment. It is also required for correct processing of claims for Medicare or other parties who contribute to medical fees.
A valid referral contains the date of the referral, the medical service/test that is referred for, the provider number of the referring doctor and the treating doctor’s name/address. Referrals from general practitioners are valid for 12 months, and from most specialists for 3 months. A general practitioner can provide an indefinite referral as well.
When you have a consultation with a doctor, or a diagnostic test, these services attract a fee.
You are responsible for paying the fee. You may have an arrangement with another person or organisation, such as Medicare or an insurance company, which will reimburse you for some or all of your medical costs. Nevertheless, you are ultimately responsible for payment of all fees generated as a result of your medical treatment. You will be informed of the expected fees when you make your appointment, and information is also available from the reception desk when you come for your appointment.
“Bulk billing” is an arrangement between Medicare and your doctor, where the doctor’s fees and charges are passed directly to Medicare, you do not receive any bills, and have no out-of-pocket expenses. When the bill is generated, it is electronically transmitted to Medicare and the payment then comes directly to the doctor. Doctors may, at their discretion, offer bulk billing to individual patients
Private health insurance is a product you can buy, which will enable you to claim some or all of your medical costs for private hospital treatment. This may help you to obtain treatment faster, or to get a greater range of treatment than is available in the public hospital system. You also get to specify your treating doctor. As of 2010 there are no private insurance benefits payable for non-hospital services, such as those provided at the Heartwest clinics. Extras cover does not apply to most medical services.
When you make an appointment, the reception staff will inform you about the expected fees and charges. A list of fees is also displayed prominently in the waiting area. Individual doctors set their own fees. Reception staff process the payments on their behalf. There is a discount for paying the account in full on the day. EFTPOS facilities are available and credit cards are accepted. If the service performed attracts a rebate from a third party such as Medicare, you can then present the receipt to Medicare or another party for reimbursement of your costs. Electronic Medicare claim submission is available at each site. If you provide your bank details to Medicare, the rebate is processed much faster, and will be deposited directly into your account. You may choose to pay your account later, but additional charges apply and are displayed at each clinic
Medical treatment is best viewed as a partnership between the patient and their treating doctor. Generally, the doctor who ordered the test is responsible for checking the result and talking to you about it. Heartwest will deliver the results to your doctor by fax / electronic delivery / post, as preferred by your doctor, as soon as they are available. It is important that you have an appointment with your doctor to go over your results.
Information sheets are available in each clinic and describe the procedures. Please read them before your test. Some information sheets are available in this website.
At Heartwest, individual doctors are responsible for setting their own fees, and the decision to bulk-bill will be made on a case-by-case basis. Please discuss this with your doctor. Diagnostic services, with the exception of 24-hour blood pressure monitoring are all bulk billed at this stage.
The simple explanation is that bulk billing generally does not cover the entire cost of providing many medical services. The agreement between Medicare and individual doctors which allows bulk billing involves a large discount applied to medical fees. When Medicare in its current form was introduced in 1984, the government decided on a list of fees payable for various medical services. In 1984 the fees were a more realistic estimate of medical costs, but in the last 26 years they have not kept up with the rising cost of operating a medical practice. Bulk billing generally involves a further 15% discount on this government fee, which most doctors would consider to be inadequate to start with. In spite of this, many doctors have continued to provide some bulk billed services within their practices.