FAQs
This information is to outline the billing process through Western Diagnostic Pathology and should answer most of your questions. Should you have any further queries please contact our Accounts Department on (08) 9317 0799.
FAQs
- Will I receive an account?
- If I am privately billed what out of pocket gap expenses will I incur?
- Does Medicare rebate all pathology tests?
- If I am a hospital in-patient will I receive an account?
1. Q: Will I receive an account?
A: If you are a Pensioner or the holder of a current Health Care Card you are eligible to be bulk billed. If all the conditions required by Medicare for direct billing are met, you will not receive an account from Western Diagnostic Pathology for Medicare rebated tests. Your account will be billed directly to Medicare. If you are the holder of Veteran Affairs Gold Card you are eligible for your account will be billed directly to the Department of Veteran Affairs. In circumstances where we are unaware of any of the above concession states, or the Medicare regulations are not satisfied, you will receive an account.
If your pathology request relates to pre-employment medicals or insurance medicals and has been requested and authorised for payment by the associated organisation your account will be sent directly to the organisation.
If you do not hold the concession cards mentioned above you will be privately billed.
If you are privately billed you will receive an account.
2. Q: If I am privately billed what out of pocket expenses will I incur?
A: Private account charges for pathology 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.
Western Diagnostic Pathology has a gap protection policy, which means after claiming from Medicare the maximum out of pocket expense will be no more than $190.00 per referral , for Medicare rebated tests performed by Western Diagnostic Pathology in the community (i.e. not in the Hospital or Day Surgery setting). See further down for information relating to hospital stays.
3. Q: Does Medicare rebate all pathology tests?
A: No, some tests are not eligible for a Medicare rebate. Examples of these include Thinprep, Amnio-Express QF-PCR.
Some tests are only eligible for a Medicare Rebate if you satisfy certain clinical conditions. HPV and BNP are examples of such a test.
If you are having one of these tests and would like to know the out of pocket expenses, the staff at our Collection Centres will be able to advise you of the associated costs.
For details on how to pay your accounts please refer to the information provided on the back of your invoice.
4. Q: If I am a Hospital or Day Surgery in-patient will I receive an account?
A: Patients with Private Health Insurance
We have agreements with a number of private health funds including CY Health, GMF Health, HBA (also known as AXA, National Mutual, BUPA), HBF, HCF, MBF, as well as the Australian Health Service Alliance Funds.
These agreements allow for those health funds to be billed directly for your pathology services whilst you are a private patient in a public or private hospital. You will not receive an account from Western Diagnostic Pathology and you will not incur out of pocket expenses for Medicare rebated tests performed by Western Diagnostic Pathology.
If you have private health insurance, but are not a member of any of the health funds listed above, you will receive an account. You are eligible to receive a reimbursement from Medicare and your Private Health Care Fund. After claiming from Medicare and your fund, your maximum out of pocket expense for rebateable tests will be $500 per hospital stay.
A: Pension and Health Care Card holders with Private Insurance.
If you are a current Pension or Health Care Card holder and have private health insurance with a fund other than those mentioned above, you will receive an account for pathology performed by Western Diagnostic Pathology whilst a hospital inpatient. Western Diagnostic Pathology will accept the Medicare payment and the payment from your private health fund as full payment. You will not incur out of pocket expenses for Medicare rebated tests. Please note that you may need to inform us of your concession status.
A: Patients without Private Health Insurance
If you are a patient without private health insurance and are not the holder of a Pension or current Health Care Card you will receive an account. You will be able to claim a portion of this from Medicare and you will be required to pay the balance.
A: Pension and Health Care Card holders without Private Health Insurance
If you are the holder of a Pension or current Health Care Card and do not have private insurance you will receive an account. Western Diagnostic Pathology will accept the Medicare Schedule Fee as full payment of this account. Medicare will reimburse 75% of this Schedule Fee and you will be required to pay the balance. Please note that you may need to inform us of your concession status.
A: Veteran Affairs Gold Card holders
If you are the holder of a Veteran Affairs Gold card and we are aware of this at the time, your account will be billed directly to the Department of Veteran Affairs for payment. You will not incur out of pocket expenses.
A: WorkCover claims
If your pathology relates to a WorkCover claim, your account will be sent directly to this organisation.