Important Note: Fees for pathology testing are separate from those charged by your doctor.

Outpatient Services



Tests Covered by Medicare



All tests covered by Medicare are listed in the Medicare Benefits Schedule. The MBS is managed by the Department of Health and administered by Medicare Australia. Medicare rebates comprises of the Australian government's subsidy for the pathology tests listed in the Schedule.

Capital Pathology routinely

  •  Bulk bills all Pension Card Holders, Health Care Card Holders and children under the age of 16

 

Examples of a Pension Card and a Health Care Card   

  Pension Concession Card 2013   Health Care Card 2013

 

  •  Direct bills the Department of Veterans' Affairs for DVA Gold and White Card Holders

 

Example of a DVA Gold Card



Vet Aff Gold Card

 

Capital Pathology has a Maximum Gap Policy of $50.00 for outpatient testing covered by Medicare.

 

Non-Medicare Rebatable Tests



Patients are billed privately for any/all tests not covered by Medicare. Where applicable, this cost is in addition to the maximum gap payment.

Pathology tests done for the following purposes, for example, are considered to be non-rebatable tests: employment, immigration/emigration, insurance cover, superannuation, work cover and visa applications.

 




Inpatient Services



In-patient pathology tests are performed for patients who are admitted to a private hospital or approved day surgery facility and private patients in a public hospital.


Tests Covered by Medicare



  •  Patients with Private Health Cover


Patients who have private health insurance with a Health Fund that has a no-gap agreement with Capital Pathology may have their account billed directly to Medicare Australia and the Health Fund. The patient does not incur any additional out of pocket expenses.

Patients who have private health insurance with a Health Fund with which Capital Pathology has not entered into a "no-gap" agreement will receive an account for the testing performed during their stay in hospital. Medicare and the Health Fund will cover costs at 100% of the Medicare Benefits Schedule. The patient is responsible for payment of the balance. The latter amount stems from the fact that Capital Pathology's fees are based on those recommended by the Australian Medical Association (AMA). Rebates for the tests covered by Medicare can be claimed from Medicare Australia.

Please note: NIB is the largest health fund which does not have a "no-gap" arrangement with private pathology providers. All patients insured with NIB are responsible for their out-of-pocket costs.



  •  Patients without Private Health Cover

 

Uninsured patients are responsible for the settlement of pathology accounts. Rebates for the tests covered by
Medicare can be claimed from Medicare Australia.

 

Non-Medicare Rebatable Tests

Patients are billed privately for any/all tests not covered by Medicare. Where applicable, this cost is in addition to the cost of Medicare rebatable testing.

 


 

Individual Testing not Covered by Medicare

Tests are billed as non-Medicare testing for the account of the patient or company (as per agreement where an agreement is in place).

 



International Patients without Medicare Cover

Accounts for both outpatient and inpatient services are billed as specified below.

International Students

With the two exceptions below, pathology costs for International Students and any children of International Students (with and without health insurance) are for the account of the individual patient. Patients with health insurance may claim any rebates as per the cover from the insurer.

Capital Pathology direct-bills accounts for International Students insured by OSHC Allianz and Medibank Private.

Other International Patients

Pathology testing for International Patients other than students and any children of International Patients (with and without health insurance) are billed at AMA rates for the account of the individual patient. Patients with health insurance may claim any rebates as per the cover from the insurer.


For any further enquiries please contact our Accounts Receivable Department on 02 6285 9888.

Refer to the section Patient Account Payment for more information on the various payment options.


 

Refund Policy

Please be advised that refunds may incur an administration and processing fee of $40, which will be deducted from the refundable balance.