How do I claim from Medicare?
Bulk billing
You do not need to claim from Medicare as the doctor will bill Medicare directly.
Bulk-billing is when the doctor bills Medicare directly, accepting the Medicare benefits as full payment for a service. The doctor cannot make any additional charge for a service, nor can any other person or company. This means if the doctor bulk bills, you cannot be charged a booking fee, administration fee, a charge for bandages, record keeping or a charge by the doctor’s company.
Most doctors’ bulk bill some of their patients, such as pensioners or health care cardholders. You will be asked to sign a completed form after the service if the doctor bulk bills. You must always be given a copy of the completed form.
There are circumstances where more than one service can be provided at the same visit and the doctor is not required to bulk bill in respect of each service.
Medicare offices
Medicare has 238 offices around Australia where claims can be made either over the counter or using the Medicare drop box or by visiting your nearest Medicare Office.
Claiming from a medical practice
Why visit a Medicare office? You may be able to see your health care professional and Medicare at the same time. There are medical practices around Australia offering you the convenient option of lodging your Medicare claim after your appointment.
It only takes a couple of minutes and a few easy steps to lodge your Medicare claim at a medical practice. Once you’ve given your consent to the practice manager, your claim will be sent online to Medicare for processing. Your benefit can be deposited into your bank account within four working days.
Here’s what you do:
- Check that your medical practice offers online Medicare claiming.
- Bring your Medicare card to your appointment. Your Medicare card number will be used to lodge the claim. If the details on your Medicare card are not up-to-date this could delay the processing of your claim. To check if your details are current, call Medicare on 132 011.
- Bring your bank account details and BSB number to have your claim deposited directly into your account. If you choose not to provide your bank account details, you will receive a cheque in the mail.
It’s that easy!
So next time you have an appointment at your medical practice, find out if they are offering online Medicare claiming.
By mail
You can send your completed claim form [PDF, 66Kb]
together with the original accounts and receipts, to Medicare, GPO Box 9822 in your capital city. Do not send your Medicare card when you claim by mail.
Telephone
You can call Medicare, give your claim details and then post your receipt and account - no claim form is required. Medicare will process your claim and pay your benefits into your nominated bank or send you a cheque. You can call 1300 360 460, 24 hours a day, seven days a week.
Medicare Australia Access Points
Medicare Australia Access Points are located throughout Australia in Rural Transaction Centres, state government agencies, pharmacies, post offices, locally based shops and even service stations. As with telephone claiming, you speak directly to a Medicare operator who will take down all of your details and begin processing your claims. Your documents are sent to Medicare and once these documents have been verified, the payment will be made. To find your nearest Medicare Australia Access Point, visit other Medicare claiming facilities.
Medicare two-way
Medicare claims can be lodged at participating private health funds which will then send your claims on to Medicare. You can also fill in a Medicare two-way claim form and leave your participating private health fund accounts and receipts with Medicare. Medicare will pay any Medicare benefit owing to you and will send the rest of the claim to your private health fund for payment.
More information about Medicare two-way.
How will Medicare pay my benefit?
Electronic Funds Transfer (EFT)
If you have paid in full for your medical service, your Medicare benefit can be deposited directly into your financial institute account. Payment by EFT is faster than payment by cheque through the mail. To receive your payment by EFT you will need to provide your account details, including the BSB (branch identification number). Medicare claiming is strictly confidential. Your bank details will only be used to deposit your Medicare benefit.
Cash
If you have paid in full for your medical service and you claim at a Medicare office, you can request payment by cash (up to the branch cash limit) and you don’t have to fill in a claim form.
Cheque
If you have not fully paid the account for your medical service, or you do not wish to receive your Medicare benefit by EFT or cash, a cheque will be sent to you by mail. For accounts that have not been paid, a cheque will be sent to you made payable to the doctor. You should give the cheque to your doctor along with any outstanding balance.
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Last updated: 28 May, 2008