Private Prescription Blood Test - Medicare

takloohaivan on 08/10/2025 - 15:14

My GP referred me to a specialist who asked me to do some blood tests. The printer was broken so she wrote the test by hand on the standard DHM pathology page. When i went to do the blood test the lady said it will not be covered under medicare as it is private. I was there and did not think much and got the test done. I had to follow up with DHM to get the invoice and got a shock as the test costs $387.

The invoice has a note that says that estimated payments from Medicare - $177 and out of pocket - $210.

Any advice as how can I get this covered under Medicare? Can i ask the specialist for a referral under medicare (not sure if they would provide one) and give that referral and this invoice to medicare and claim the full amount back.

Google AI says that the benefit for these tests is 75% or 85%. DMH has charged around 70-80% more than the costs mentioned on medicare benefits schedule.

TH

Financial Blood Test

Comments

  • Duckie2hh on 08/10/2025 - 15:16
    +2

    I was there and did not think much and got the test done

    Caveat Emptor

  • JimB on 08/10/2025 - 15:19
    +7

    "When i went to do the blood test the lady said it will not be covered under medicare as it is private. I was there and did not think much and got the test done."

    They advised you it wasn't covered but you didn't think to ask at the time?

    Live and learn.

  • jv on 08/10/2025 - 15:56
    -2

    You're GP should have told you whether it would be bulk billed or not…

    Lots of tests are, some aren't…

    • Agarwal on 08/10/2025 - 16:14

      How do you know they are GP?

      • jv on 08/10/2025 - 16:25
        -2

        I assumed their occupation.

  • jv on 08/10/2025 - 15:57
    -4

    the lady said

    Did you assume her gender ??? 😲

  • takloohaivan on 08/10/2025 - 16:15

    Are there any tests that medicare covers only part and we have to pay out of pocket?

    Otherwise, I should have gone back to my GP, paid GP another 50 bucks to get the same tests under medicare and saved myself 160 bucks (assuming i get some amount back from medicare).

    It is so unfair that DHM charges different rate to a private patient and a medicare one. the test costs are test costs and pathology's should not be allowed to have 2 different rates.

    • MS Paint on 08/10/2025 - 16:45

      🎻

    • freefall101 on 08/10/2025 - 17:02

      Depending on whether the tests you got were actually covered under medicare, not all of them are.

      And bulk billing hugely simplifies the billing structure for them, so often places will bulk bill out of convenience, even though they could make more money by charging more and claiming back the medicare amount.

    • Summoner on 08/10/2025 - 20:28
      +1

      If you know the test you've done, check if it's bulk billed under Medicare. Last time I visited pathologists about 10 days ago, they had a sign saying that some blood tests would incur an out-of-pocket fee. The test you've done may have been one of those.

  • sam-1966 on 08/10/2025 - 16:59
    +1

    It's possible that just didn't tick the 'bulk bill' box that most doctors do tick.

  • Clear on 08/10/2025 - 18:50

    When they click print an electronic order is sent to the pathology lab regardless if the paper printed or not. Then the lab would have a valid referral electronically.

    Of course a lot of collection staff don't know this and it's possible the practice haven't set it up. Since it's DMH it's very unlikely for eOrders not to be setup, as they require all practices to have it. The same applies to any Sonic owned lab.

    For their hand written note to be valid for bulk billing they would have to include their details including name, practice, practice address, provider number (super important), test item numbers and of course signature.

    Perhaps let your specialist know and they may be able to reissue it and maybe the lab will re-accept it. If you took it to Medicare for manual claiming they would likely reject it if it's missing the required details above.

    In saying that, as you've discovered not all tests are fully covered and the lab can charge more than what the Medicare item number says. This is widespread amongst GPs, specialists, surgeons and imaging.

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