Patient billing information

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 the private health insurance funds so that patients do not have to pay a gap for their pathology testing.

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 account that must be presented to Medicare to receive a full 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 their health fund and Medicare to receive a refund.

Information for non-Eligible Patients

A person who does not hold a current Australian Medicare Card is classed as a non-eligible patient. ACT Pathology have to raise invoices for all services for non-eligible patients.

Pathology Service Fees: Where a Pathology service has been provided the fee will be 270% of Medicare Benefits Schedule per item.

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 thier Health Fund prior to having the service performed.

Tests not performed by ACT Pathology

There are some specialised tests that are not performed by ACT Pathology. These tests are referred to accredited laboratories.

Billing is at the discretion of the referral laboratory. If they bill at Medicare scheduled rebate, this means that patients do not have to pay a gap. If we have received the patient's Medicare number and an assignment form we will pass this on to the reference laboratory for bulk-billing.

If the laboratory does not accept Medicare scheduled rebate, the patient is responsible for the account.

Where referred tests are not eligible for Medicare the reference laboratory will bill private inpatients and privately referred outpatients.

Services not eligible for Medicare

Tests or services that do not have a Medicare item number do not attract a Medicare rebate.