Do I have to pay out-of-pocket fees for treatments outside of hospital?

There are 3 scenarios when you may have to pay out-of-pocket fees for treatments outside of hospital: 

1. When receiving medical services in a clinic or practice, e.g. diagnostic tests 

2. When receiving healthcare from a GP  

3. When receiving treatment for dental or allied health services, e.g. physiotherapy. 

What are the out-of-pocket fees for medical tests outside hospital? 

If Medicare covers your diagnostic test outside a hospital, such as blood tests and radiology services, it will pay 85% of the Medicare Benefits Schedule (MBS) Fee. If the service provider or clinic charges more than 85% of the MBS Fee, you pay the difference out of ‘your’ pocket. Legislation does not permit health insurers to cover the difference.  

Check with your medical test provider about the out-of-pocket fees that apply.  

What are the out-of-pocket fees for GP visits?  

For GP visits, Medicare pays 100% of the MBS Fee. If your GP charges the same amount as the MBS Fee, the service is bulk billed and you will not have any out-of-pocket fees. But if your GP charges more than the MBS Fee, you pay the difference out of ‘your’ pocket. Legislation does not permit health insurers to cover that difference.  

Check with your GP about the out-of-pocket fees that apply.  

What are the out-of-pocket fees for dental and allied healthcare services?  

Medicare does not cover most dental services nor most allied healthcare services outside hospital, including physiotherapy, occupational therapy, speech therapy, chiropractic, podiatry and psychology. If you do not have an Extras Cover policy, you must pay the full fee for dental and allied healthcare services. If you do have Extras Cover, the out-of-pocket fees will depend on your policy.  

If you have Extras Cover but the dentist or allied healthcare provider’s fee exceeds the amount covered by your policy, you will pay the difference out of your pocket.  

Check your policy details or ask your insurer about how much is covered by your Extras policy. 

What are the out-of-pocket fees for treatments in hospital?