How medical bulk billing works in Australia

24 January 2017
 Categories: Health & Medical , Blog


A healthcare professional bulk bills a patient when they accept Medicare benefits as full payment for the services rendered. In order to understand how bulk billing works in Australia, it is important to have an idea of the concept of Medicare benefits. Medicare is the main vehicle through which the Commonwealth Government of Australia provides Australians, permanent residents and visitors from Reciprocal Health Care Agreement countries with subsidised medical services, including prescribed low-cost medications and free treatment at government hospitals. Medicare is administered by the Department of Human Services on behalf of the Department of Health, and they pay medicare benefits to users for various healthcare expenses.

These benefits fall into three main categories. The first is free treatment at public hospitals, but this does not include ambulance or transportation costs to the hospital. The second category is non-hospital–related treatment eligible under the Medicare Benefit Scheme, and this includes the cost of attending a doctor's surgery or seeing a specialist. Medicare pays a benefit up to a certain percentage of a specialist doctor's fee (usually 85 percent) for services the specialist provides. The third category is prescription medications under the pharmaceutical benefits scheme. Patients are expected to bear out-of -pocket expenses not covered under the Medicare Benefit Scheme.

Bulk-billing doctors accept the Medicare benefit as full payment for the cost of services they rendered. By billing Medicare, the user has passed the right to a Medicare benefit to the service provider. To enable the service provider to do this, users are expected to sign and retain a copy of a form after the appointment. The patient is not charged additional costs such as administrative or out-of pocket expenses.

Patients attending surgeries that do not bulk bill must keep in mind that Medicare benefit does not cover out-of-pocket expenses and that only 85 percent of scheduling fees is covered when taking treatment from a specialist doctor. Out-of-pocket expenses can be avoided by attending only services provided by bulk-billing doctors or by taking out private health insurance. It is also pertinent to note that patients having more than one service during a doctor's visit may not necessarily be bulk billed for all the services.

Bulk-billing doctors cannot charge additional fees over Medicare benefit, so some practices limit bulk billing to specific categories of patients such as children and the elderly while others limit bulk billing to certain times of the day. Other practices will offer bulk billing to patients who pre-book for consultation with a psychologist. In order to incentivise doctors, Medicare now makes extra payment to doctors working in eligible areas who bulk bill pensioners, young children and healthcare card holders. 

Bulk billing still remains popular in Australia, as it enables many Australians to afford visits, but it is important to check whether a doctor's practice bulk bills before making an appointment. Patients who cannot afford to pay a gap fee should ensure that they visit only bulk-billing doctors if they do not have healthcare insurance.