What is bulk billing and how does it work in Australia?

May 25, 2022 | Tips

In Australia we’re blessed with access to Medicare and its accompanying billing system – bulk billing. Many don’t really understand how bulk billing actually functions. Let’s jump into a quick review of bulk billing in Australia and how it works through the Medicare system.

What is the role of Medicare in bulk billing?

The Australian Labor government introduced Medicare in 1984, the government’s Australia wide health care program.

Medicare focuses on providing Australians efficient and free coverage for healthcare and is financed by the Medicare levies in Australia.

All Australians are eligible to receive Medicare coverage and rebates and, in many circumstances, have their medical bill fully covered by a practice called ‘bulk billing’.

So what is bulk billing in Australia exactly?

Bulk billing is the process by which Australians have their medical costs covered by Medicare.

All health professionals need to be paid for their health services. As such, many medical healthcare professionals provide their services at no upfront cost to the Australian patient.

Instead of the patient paying their medical bill at the practice, the medical professional or doctor will instead bill the appointment and treatment directly to Services Australia through Medicare’s bulk billing service.

What doctors bulk bill?

Not every doctor or health pro bulk bills. Furthermore, not every medical service is bulk billable.

Many GP’s for example are private operators and do not sign up to bulk billing. This will usually be abundantly clear upon booking an appointment. For these doctors, you will have to pay upront.

Bulk billing, however, is pretty widespread across most GP’s and services like x-rays and pathology.

Many other medical practitioners, such as physio’s and dermatologists will charge you upfront, yet you may be able to get some of that money back through Medicare rebates.

What services can be bulk billed?

Bulk billing usually covers all visits of a general practitioner (GP) or other medical procedures. Service Australia claims that bulk bill covers: It does not generally apply to inpatient care for hospitals.

Let’s take a look at what is (or can be) covered by bulk billing in Australia.

  • GP’s
  • X-rays and other scans
  • Pathology
  • Optometrists

What does bulk billing not cover?

There are many health services not covered by bulk billing or Medicare.

Bulk billing is not available for:

  • Dentistry and orthodontics
  • Some types of scans (excluding x-rays)
  • Specialists

What’s the gap fee?

The term gap fee, or Medicare rebate, refers to the difference in medical fees with a medical bill, where Medicare pays the reimbursement.

This will be a sum you’ve billed out of your own pocket and applies to all consultations which do not attract bulk billing.

The Medicare rebate is calculated using Medicare’s Medicare fee schedule. In most medical offices, a patient’s procedure costs can vary significantly between clinics. Usually if a consultation doesn’t come with a bulk bill you must pay all fees at the consultation.

Can you request a bulk-billed consultation at any clinic?

Not necessarily. As touched upon, some medical facilities provide bulk billings for some customers, however not others, so describing your circumstances before calling them might help them to know that you have eligibility.

Give them a chance to ask about your concessions. You can look for a doctor who is able to bill you for a lot of expenses by visiting the Australian Healthdirect site.

Keep in touch with the GP or receptionist to find out the discounts that may apply to certain patients. Getting medical bills in advance could also be helpful.

GP referrals for bulk billing physiotherapy

Even though Medicare does not specifically cover many health services, like physiotherapy, if your GP refers you, they may still bulk bill.

For example, there are certain provisions for doctors to refer a patient to a bulk billing physio such as under a Chronic Disease Management Plan.

More information about bulk billing and Medicare

If you require more information about bulk billing and Medicare, please visit the Services Australia page here.


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