Billing policy | QML Pathology

Medicare rebate eligibility

Your Medicare rebate is the subsidy provided by the Australian Government for pathology services that are included in the the Medicare Benefits Schedule (MBS) and satisfy any eligibility criteria.

Most pathology services will be eligible for a Medicare rebate but some are not included in the MBS (or are only eligible if certain eligibility criteria, including clinical and/or personal criteria, are satisfied).

In the case of services that are eligible for a Medicare rebate, we may charge non-concessional patients an amount in excess of the relevant rebate.

If any of the pathology services requested by your doctor are not included in the MBS or you do not satisfy the applicable eligibility criteria, you will not receive a Medicare rebate.

For more information about pathology services that are included in the MBS, eligibility and how to claim your Medicare rebate, visit the Medicare website at medicare.gov.au or contact Services Australia on 132 011.‍

Medicare rebate exclusions

In the case of pathology services that are not eligible for a Medicare rebate because they are not included in the MBS, you will incur a charge that will need to be paid at time of specimen collection (if your specimen is collected at one of our Collection Centres) or after testing has been finalised (if your specimen is collected by someone other than us, for example, by your doctor or a hospital).

For pathology services where eligibility for a Medicare rebate is conditional on the satisfaction of certain criteria, you will incur a charge that will need to be paid after testing has been finalised if those criteria are not satisfied.

If you visit one of our Collection Centres, we will be able to inform you about any services that are not eligible for a Medicare rebate or are only eligible for a rebate if eligibility criteria are satisfied. Your doctor should also be able to inform you about such services.

I am an out-patient (not admitted in hospital) with a valid Medicare card

Medicare rebates apply for most out-patient pathology services. However, some services are not included in MBS so that no Medicare rebate applies (or they are included in the MBS but only eligible for a Medicare rebate if certain eligibility criteria are satisfied).

Concessional patients will be bulk billed and will not receive an account from our pathology for pathology services that are eligible for a Medicare rebate, and may be charged concessional fees for other services – see below. Non-concessional patients may be billed for pathology services that are eligible for a Medicare rebate.

Patients will be billed for pathology services that are not included in the MBS or where the eligibility criteria for a Medicare rebate are not satisfied. Patients whose specimen is collected at one of our Collection Centres will be informed of any services not included in the MBS, or that are subject to eligibility criteria, at the time of that collection.

Bulk Billing

Your specimen collection is performed at one of our collection centres:

If you specimen collection is performed at one of our collection centres, we will require you to present your valid Medicare card at that time in order for us to be able to bulk bill any the pathology services that are included in the MBS and where any applicable eligibility criteria are satisfied.

Your specimen collection is performed by a person other than our pathology:

If your specimen collection is performed by a party other than us, they will need to supply us with your valid Medicare card information and personal details in order for us to be able to bulk bill Medicare for any pathology services that are included in the MBS and where any eligibility criteria are satisfied.

Otherwise than in respect of concessional patients, bulk billing is at our discretion.

Private Billing

Your specimen collection is performed at one of our collection centres:

If we can ascertain that your Medicare card is valid but your doctor has requested pathology services which are not included in the MBS, we will require that you pay for those non-eligible tests in full at the time of specimen collection.

If we can ascertain that your Medicare card is valid but your doctor has requested pathology services which are only eligible for a Medicare rebate depending on the satisfaction of certain criteria (including personal or clinical criteria), our collector will be able to advise you of this. If the applicable criteria are not satisfied, we will issue you with an invoice (usually by SMS) once testing has been completed and results sent to your doctor.

If we cannot ascertain that your Medicare card is valid, we will request that you pay for all your testing in full at the time of specimen collection.

Your specimen collection is performed by a person other than our pathology:

If your doctor has requested pathology services which are not included in the MBS or which are subject to Medicare eligibility criteria that are not satisfied, we will require that you pay for those services in full. We will issue you with an invoice (usually by SMS) once testing has been completed and results sent to your doctor.

If your doctor has not provided us with your valid Medicare card information and personal details we will require you to pay for this testing in full. We will issue you with an invoice (usually by SMS) once testing has been completed and results sent to your doctor.

Claiming your rebate from Medicare:

If we requested that you pay for any or all of your pathology services, we will provide you with the necessary information for you to request an itemised receipt, which you will be able to use to claim your Medicare rebate for any tests eligible under the MBS.

An itemised receipt will be available as soon as all testing has been completed and the results sent to your doctor (typically 3 to 5 days after your specimen has been collected, depending on the complexity of testing requested) and your invoice has been paid in full.

I am an out-patient (not admitted in hospital) with a concessional card

If you are a concessional patient, you will be bulk billed and will not receive an account from our pathology for pathology services that are eligible for a Medicare rebate.

If a person other than our pathology (for example, your doctor) is collecting your specimen, you must provide them with the necessary information from your Concession Card and your personal details, so that we can process your concessional rates accordingly.

Concessional patients are limited to nursing home patients and holders of a valid:

Health Care card

Pensioners card

‍DVA Gold card

Holders of a current Veteran Affairs Gold Card (DVA Gold Card) will not be privately billed by our pathology for any pathology services that are included in the MBS, even if MBS prescribes eligibility criteria that are not satisfied.

I am an in-patient (hospital patient)

I am a patient with overseas private health insurance

Your specimen collection is at one of our collection centres

If you would like for us to bill your health fund directly for any rebate-eligible tests, you will be asked to produce evidence of current health insurance cover with one of the health funds in our Accepted Health Insurers list.

For proof of membership and rebate eligibility with your health fund, at time of specimen collection, you will be asked to present:

a current insurance card or electronic proof of coverage via your health insurer’s application and
an official current photo ID (e.g., driver’s licence, passport, IMMI Card)

Both of these will need to match the name on your doctor’s pathology referral.

If we can ascertain that your health insurance cover is valid, we will endeavour to directly bill your health fund directly for any tests in your referral that do meet your health fund’s rebate criteria.

If your requesting doctor has requested tests which do not meet your health fund’s rebate eligibility, we will require that you pay for those tests in full at the time of specimen collection.

If we cannot to ascertain that your health fund card is valid or your health fund is not in our Accepted Health Insurers list, we will request that you pay for all your testing in full at the time of specimen collection.

Your specimen collection is performed by a party other than our Pathology

If your requesting doctor has requested tests which do not meet eligibility criteria under your health fund’s cover, we will require that you pay for those tests in full. We will endeavour to directly bill your health fund for any tests in your referral that do meet their rebate criteria provided that:

Your health fund is on our Accepted Health Insurers list and
We can validate your coverage with the health fund

If your requesting doctor has not provided us with your valid health insurance information and personal details we will require you to pay for this testing in full. We will issue an invoice to you once testing has been completed and results sent to your doctor.

Claiming your rebate from your health fund

If we requested that you pay for your testing, you will be able to request an itemised receipt, which you will be able to use to claim your rebate for all tests eligible under your health fund’s cover.

An itemised receipt will be available as soon as all testing has been performed by our laboratory and the results provided to your requesting doctor (typically 3 to 5 days after your specimen has been collected, depending on the complexity of testing requested) and your invoice has been paid in full.

I am a patient without Medicare or private health insurance cover

If you are a patient who is not covered by Medicare or by private health insurance we will require full payment for all testing.

Your specimen collection is at one of our collection centres

If you attend one of our collection centers, we will ask that you pay for all testing in full at the time of specimen collection.

Your specimen collection is performed by a party other than us

If your specimen is collected by a person other than us, you will receive an invoice from us (usually by SMS).

Our out-of-pocket billing policy

To minimise out-of-pocket expenses, we have an out-of-pocket billing policy for collections undertaken in its Collection Centres in respect of most pathology services included in the MBS.

Under the out-of-pocket billing policy, the maximum out-of-pocket expense that will be charged in a single visit for pathology services:

(a) that are included in the MBS and any eligibility criteria are satisfied; and

(b) where the specimen is collected in our Collection Centres, is $320.

This maximum apples to out-patient testing only

Any pathology services that are not included in the MBS, or that are included in the MBS but in respect of which any eligibility criteria are not satisfied, are excluded from that $320 maximum amount. Fees over and above that maximum may be charged for such services.

The $320 maximum amount does not apply to a very limited number of pathology services that are included in the MBS. If you visit one of our Collection Centres, we will be able to inform you about any services that are not included in the maximum, despite being included in the MBS.