Medicare, Gaps and Safety Net (Part 1) - Bulk billing

With the recent discussion of paying $7 to see a General Practitioner (GP) in the budget, it seems it will be the demise of Bulk Billing.

But what exactly is Bulk Billing? When do we pay extra and how much do we get back from Medicare? What does the safety net mean? And what's the difference between scheduled fee and Australian Medical Association recommended fees? What's the Medical Levy Surcharge?

The system is indeed very complex. I hope this series about Medicare would help explain how it all works. In this post, I will focus on Bulk Billing.

According to Medicare, "Bulk Billing is when a provider bills Medicare directly for any medical or allied health service that the patient receives." [1] What this means is that you allow your doctor or allied health service* to charge Medicare directly for the particular service they have provided for you. It also means they cannot charge you any thing additional for that service.

Your doctor/ allied health professional will get back 85% of the scheduled fee (or 100% if this is your GP). (I will explain what this means in a later post.)

So the next sensible question will be why do some doctors/ allied health professionals bulk bill while others don't? Why is it increasingly difficult to find one who bulk bill? Why do some doctors bulk bill and then stop bulk billing after a while?

Here are a few reasons why your doctor might bulk bill:

• Your doctor IS running a business. He might have just started a practice and need a healthy volume of patients to keep his practice going. 
• It also could be because your doctor has just finished specialist training and needs to start getting contacts with different GPs to get a constant flow of patients. Bulk billing attracts patients to attend his practice. GPs also test various specialists out.
• Bulk billing reduces billing collection cost and the lowers risk of debt.
• Your doctor strongly feels he needs to provide for the need of those who cannot afford to pay an out of pocket fee. For example, if you have a Health Care Card or are on a pension, your doctor may be willing to bulk bill you. This tends to be easier to negotiate with a GP than a specialist.
• The practice that your doctor works in work by volume. Since billing is by units of time, if your doctor sees more than 1 patient in less than the smallest unit of time, it would cover his cost. This practice is quite controversial as it may affect the quality of care provided.

Depending on the location of the practice and type of practice, bulk billing may not cover costs. Hence, many doctors revert to billing using the Australian Medical Association recommended fees after they are more established. (I will explain this in greater detail in a later post.)

In my personal opinion, if you can afford it, try to go to a doctor who doesn't bulk bill. Care would seem less rushed and more coordinated. There is always the Medicare Safety Net to ensure if you have high health care needs, there would be limits to how much you would eventually have to pay.

* Allied Health refers to health professionals that are not doctors or nurses. For example, psychologist, physiotherapist, speech pathologist, occupational therapist, etc.

References

[1] http://www.medicareaustralia.gov.au/provider/medicare/bulk-billing.jsp

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Medicare, Gaps, Safety Net (Part 2) - How do I make a Medicare Claim?