Fees
GPs
Most Australian GPs charge their patients on a fee-for-service basis each time they see their GP.
Specialists
When you visit a specialist, you will be billed for the consultation and any procedures. Specialists charge a price that reflects their training and their expertise and the cost of running their business.
Rebates
Rebates you receive from the Commonwealth Government are based on the Medicare Rebate Schedule price for consultations and procedures.
GPs
Medicare provides a rebate each time you consult a GP. How much you receive depends on the length and type of consultation and any tests or procedures carried out.
Specialists
The rebate for specialist consultations is 85% of the Medicare rebate schedule.
If you have a specialist procedure, the rebate is 75% if you are treated as a private patient and 85% if your specialist works through a public hospital outpatients department.
If you have private health insurance you may receive another rebate (25% of the Medicare scheduled price for that procedure).
Bulk-billing and other ways to save
Over time the Medicare rebate has failed to keep pace with the costs of running a medical practice. Since 1985, Medicare rebates have on average increased by 38%, while the Consumer Price Index) has increased by 72% and average weekly earnings by 74%. This is why some doctors who used to bulk-bill are now charging patients a fee.
GPs
When Medicare first began, many GPs bulk-billed because it was easy for the patient and rebates were close to the costs of providing that service.
Some GPs still bulk-bill and many GPs bulk-bill pensioners. Bulk-billing means you sign a form for the Medicare rebate to be paid straight to the GP. You pay no out-of-pocket fee at a bulk-billed service.
Specialists
If you do not have private health insurance and cannot afford to pay for a specialist’s services, you should let your GP know your financial circumstances. You may be referred to a specialist who works from a public hospital.
If a condition is likely to be easily treated in the specialist's rooms or a day hospital, it may be affordable from a patient’s own pocket. Some people ‘self insure’ for health care by putting aside money each month in a high interest earning account and drawing on it when needed.
Gaps you may need to pay – health insurance and your financial circumstances
Patients, including health care card holders, may need to pay an out-of-pocket or gap fee to cover the difference between the Medicare rebate and the fee the GP or specialist charges for the service.
GPs
Ask what gap fee you may have to pay when making an appointment.
Pay on the day: GPs who charge a fee may ask you to pay on the day of your consultation. Sometimes there is a discount if you do this. You can then take your paid account to Medicare and get a cash rebate. Some doctors may lodge your claim for you. Your rebate can be paid straight into your bank account or as a cheque sent to your home.
Account to pay later: Some GPs may give you the account on your way out or send it to you in the mail. You will need to pay the account. You can either pay it in full and then claim your rebate or send the account with a completed Medicare form to Medicare. You will receive a cheque from Medicare in four weeks or so. Send that to the doctor with the gap shown on the bill.
Paperwork: Some GPs will perform all the paperwork for you. You then receive a cheque in the mail for the amount of your rebate, payable to the doctor. Send that to the doctor with the gap (if any) shown on the bill.
Specialists
Some private health insurance funds promise ‘no gap’ products. You should check the details of these products carefully, as there may be special conditions attached. These products may also limit your choice of treating doctor and hospital.
