Account Information FAQs
- Will I receive an account?
- If I am privately billed what out of pocket expenses will I incur?
- Does Medicare provide a rebate for all Pathology tests?
- If I am a hospital inpatient, will I receive an account?
- What services do not attract a Medicare rebate?
- How can the Medicare 'Safety Net' initiative help me?
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Q: Will I receive an account?
A: Please see below for pathology billing information:
QML Pathology is a private pathology provider and therefore may charge for the pathology tests that your doctor has requested. We would like to be able to give you an estimate of the potential total costs of any pathology tests that your doctor has ordered; unfortunately, this is not possible as the total cost varies depending on the frequency, volume and complexity of the pathology tests ordered by your doctor in accordance with Medicare rules.
However, we can advise that QML Pathology’s private fees are capped to ensure that no patient is out of pocket more than $88.00 per account for all tests eligible for a Medicare rebate (Please note this does not apply to hospital patients – refer to Inpatient section (question 4)).
You will be pleased to know that Medicare may provide you with a rebate towards the total cost of your pathology bill. As with any Medicare claim, once you have paid the account, send or take your receipt and invoice to Medicare to claim for a rebate. You should be aware that there are a number of tests and services provided by QML Pathology that do not qualify for a Medicare refund and will incur a charge.
If you are a Pensioner or a current Health Care Cardholder or your doctor has indicated that the request should be bulk billed, then QML Pathology will bulk bill all Medicare rebateable items, providing that the Medicare number is correct and that you have signed the Medicare Assignment field on the request form. If you are bulk billed, your account will be billed directly to Medicare and you will not be required to pay an account.
If you are the holder of a Veterans’ Affairs Gold Card your account will be billed directly to the Department of Veteran Affairs and you will not be required to pay an account.
If your pathology request relates to a WorkCover or Transport Accident Commission claim, pre-employment or insurance medicals, your account may be sent to you or to the relevant organisation. -
Q: If I am privately billed what out of pocket expenses will I incur?
A: Private account charges for pathology tests are based on the Australian Medical Association rates. This means the fee includes the Medicare rebate amount plus a gap payment incurred as out of pocket expenses.
QML Pathology has a gap protection policy which means that after claiming from Medicare the maximum out of pocket expense will be no more than $88.00 per account for all tests eligible for a Medicare rebate (Please note this does not apply to hospital patients – refer to Inpatient section). -
Q: Does Medicare provide a rebate for all Pathology tests?
A: No, some tests are not eligible for a Medicare rebate and will incur a charge, for example, SurePath, FISH, ambulatory blood pressure monitoring and HPV. At QML Pathology, you are likely to receive an out of pocket charge for a home visit.
If you are having one of these tests and would like to know the out of pocket expenses, please ask the staff at our Collection Centres who will be able to advise you of the associated costs. -
Q: If I am a hospital inpatient, will I receive an account?
A: Please see below for hospital inpatient pathology billing information:
We would like to be able to give you an estimate of the potential total costs of any pathology tests that your doctor has ordered; unfortunately, this is not possible as the total cost varies depending on the frequency, volume and complexity of the pathology tests ordered by your doctor during your stay in hospital in accordance with Medicare rules. However, we can advise that QML Pathology’s private fees are capped to ensure that no patient is out of pocket more than $500.00 for all tests eligible for a Medicare rebate for the duration of their hospitalisation.
Patients with Private Health Insurance (including Pension and Health Care Cardholders)
If you have pathology services referred to QML Pathology while you are a private patient in a public or private hospital, and you are privately insured with any of the main health funds, including MBF and Medibank Private, you will be charged at a no gap level.
This means that privately insured patients will NOT receive any out-of-pocket expenses relating to pathology referred to QML Pathology during their stay in hospital.
However, in the instance where we cannot bill your health fund directly, you will receive an account for all of your pathology tests performed over the length of your hospital stay. Once your have paid the account, send or take your receipt or invoice to your health fund to claim for a rebate.
You should be aware that there are a number of tests and services provided by QML Pathology that do not qualify for a private health fund refund and will incur a charge. Please feel free to contact QML Pathology or your private insurer for more information about whether you may qualify for a health fund refund.
Patients without Private Health Insurance (including Pension and Health Care Cardholders)
If you are a patient without private health insurance you will receive an account. You will be able to claim 75% of the scheduled fee through Medicare, and you will be required to pay the balance.
Veteran Affairs Gold Cardholders
If you are the holder of a Veterans’ Affairs Gold Card your account will be billed directly to the Department of Veterans’ Affairs for payment. You will not incur out of pocket expenses.
WorkCover and TAC claims
If your pathology relates to a WorkCover or Transport Accident Commission claim, your account will be sent directly to those organisations. -
Q: What services do not attract a Medicare rebate?
A: Some pathology services are not eligible for a Medicare rebate and will incur a charge. Some of the more common services in this category include Home Collection Visits and Warfarin Dosing (controlled by QML Pathology). -
Q: How can the Medicare 'Safety Net' initiative help me?
A: If you need to see a doctor or have pathology tests regularly, you could end up with high medical costs. The Medicare Safety Net is designed to help you when you need it most. It means that once you reach a Medicare Safety Net threshold (within a calendar year) your out-of-pocket expenses may be reduced. The Medicare Safety Net covers a range of medical services that you receive out of hospital.
Further information can be obtained by downloading our Pathology and the Medicare Safety Net brochure or visiting the Medicare Australia website.
