Client Information

Billing Information & Medicare

ACT Pathology is a public laboratory that provides services to both public and private patients.

Under our "No-Gap" Billing Policy, we bill through Medicare, Veterans Affairs and private health insurance funds. This means Medicare eligible clients do not have to pay a gap for eligible pathology testing.

Please check with your health fund and Medicare to see if you qualify for our no-gap billing policy.

Outpatients

We require a patient’s Medicare number and signature in the assignment box on the request form to bulk-bill eligible outpatient services. Patients who do not complete the assignment box will be issued an invoice that can be presented to Medicare to receive a refund.

Private Inpatients and Day Stay Patients

ACT Pathology has arranged simplified billing agreements with most health funds. We can send pathology accounts directly to the health fund if we are provided with the patient’s Medicare number, health fund name and membership number on the request form. If these details are not provided the patient will be issued an invoice. The patient must present this invoice to Medicare firstly and their health fund to receive a refund.

Non-eligible Patients

A Non-eligible person is defined as:

a person who is not an Australian resident (definition provided from the determination)

(a) Australian resident means a person who resides in Australia and has permission to remain permanently – either because they are:

  1. an Australian citizen;
  2. a permanent residence visa holder; or
  3. a protected Special Category visa (SCV) holder.

(b) does not hold a valid Medicare card; or

(c) a person in respect of whom, or a person included in a class of persons in respect of which, there is in force an order under subsection 6(2) of the Health Insurance Act 1973 (Cwlth);

A Non-eligible Student means a person who meets the criteria as stated for a non-eligible person and is studying at an Australian university or training institute and holds current Overseas Student Health Cover.

Pathology Service Fees for Non-eligible Clients

Where the Pathology Service provided involves Inpatient or Outpatient Services the fee for a non-eligible person will be:

  1. without Student Cover 270% of Medicare Benefits Schedule Fee
  2. with Student Cover 100% of Medicare Benefits Schedule Fee

Those clients with Overseas insurance are responsible for any gap payment of fees that their fund may not cover. All patients are advised to discuss this with their Health Fund prior to having the service performed.

Tests not performed by ACT Pathology

Some specialised tests are not available from ACT Pathology. These tests are referred to accredited laboratories.

Billing for these tests is decided by the referral laboratory. ACT Pathology will pass on your Medicare number and assignment form for bulk-billing. If the laboratory does not accept the Medicare scheduled rebate, you are responsible for the cost.

Services not eligible for Medicare rebate

Some tests and services are not covered by the Medicare Schedule and do not attract a Medicare rebate, so patients are required to cover the full cost of testing. 

If you receive this testing from ACT Pathology, we will issue you with an invoice.

If we refer your specimens to another laboratory for testing, you will either receive an invoice from the referral laboratory or be on-billed by ACT Pathology.

If you require any further information regarding billing of your pathology tests contact Pathology Accounts on 02 6174 8700.

Page last updated on: 1 Oct 2018