Patient Account Information
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Have a query about an account?
Wondering how you were charged or why you were charged? Unsure how to claim with Medicare?
Capital Pathology is a private provider of specialist pathology services. Like other specialists and medical practitioners, there is a cost associated with services we provide. Below we have outlined the majority of questions people ask when receiving an invoice.
Capital Pathology's Billing Policy
Our billing policy is to bill concession card holders, children under 16 and Veteran Affairs to Medicare. All tests covered by Medicare are listed in the Medicare Benefits Schedule.
Non-concessional patients may be privately billed and receive an account from Capital Pathology.
Patients with Medicare who are privately billed will have a capped out of pocket expense of $50
Patients without medicare (overseas visitors/students) are invoiced based on the Australian Medical Association (AMA) list of medical services
The billing procedure for pathology testing is a complex process that is dependant on a number of variables including whether the test is fully rebatable by Medicare and whether is needs to be referred to another laboratory.
We aim to be reasonable with our fee structure. Fees are set as low as possible within the bounds of providing a high quality, comprehensive pathology service.
Non-Medicare Rebatable testing
Medicare rebates apply for most pathology testing.
For some tests, Medicare requires that the patient satisfy specific clinical criteria in order to receive a rebate, or limits the frequency of testing, or in some cases both. Some tests do not qualify for a rebate under any circumstances, these are known as Non-Medicare Rebatable.
Some examples of these tests include some genetics tests, Faecal Calprotectin, Blood Pressure monitoring.
Click here to check if your tests will be covered by Medicare
Understanding inpatient and outpatient services
Outpatient Services refers to patients who have used our services outside of being in hospital, for instance visiting one of our collection centres.
All tests covered by Medicare are listed in the Medicare Benefits Schedule.
Not all tests have a Medicare rebate. Patients having this testing performed are billed privately for any tests not covered by Medicare.
We always strive to provide this information when patients present to our collection centres.
Inpatient 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.
Patients who have private health insurance with a Health Fund that has a no-gap agreement with Capital Pathology will bill directly to the Health Fund
How do I claim with Medicare?
There are two ways you can claim with Medicare
- Pay the account in full, wait until the official receipt has been received with a zero balance then claim with Medicare. Either in a Medicare office or online via MyGov website or Medicare app. The rebate will then be deposited into the nominated bank account.
- OR Patients can claim first with the invoice then Medicare will take anywhere from 4 - 12 weeks to create a cheque for the rebate amount. The cheque will be made out to Capital Pathology but Medicare will post it to the patients home address. After this has been received, we require the cheque to be forwarded to Capital Pathology and pay any outstanding gap (if there is one). Our postal address for the cheque is
PO Box 20, Woden ACT 2606 or it can be dropped it off at any of our Collection Centres.
Frequently asked questions
Circumstances where Medicare rebates are not eligible
Tests requested in any of the following circumstances are not eligible for a Medicare rebate:
- Health screening
- Work cover
- Visa application
I've never received an invoice for pathology before, why do I have one now?
Capital Pathology is a private specialist pathology and like all specialists, there is a cost associated with services we provide.
- Patients who have medicare we discount all testing possible to ensure that the out of pocket expenses are at $50
- When Non-Medicare rebatable tests are performed the cost for testing is required from the patient.
- Patients who don’t have Medicare will be charged at AMA (Australian Medical Association) rates and payment is required at time of collection.
- In the cases where patients dont have Medicare, our collection team will call our quote line (open Monday – Friday 9am to 5pm) to find out the cost of the testing you require.
Will my Medicare rebate be automatically paid into my account?
Medicare rules state that Pathology can only be claimed after tests have been completed at the Laboratory. This means we cannot claim on behalf of a patient at the time of collection.
Why have I received an invoice without being consulted first?
Capital Pathology’s protocol for the collection of specimens is to explain our billing policy and obtain informed financial consent from patients who present to our Collection Centres.
However, this is not always possible, particularly when our staff are not involved in the collection of the specimen. We believe in good faith that practitioners will explain there is a potential cost for testing at the time of consultation.
Why am I being charged for Cervical Screening?
Recently Medicare have changed their regulations for Cervical Screening and will now only cover the cost of routine cervical screening once every 57 months (5 years).
If you have had testing done within this time period, then the cost of testing is now required to be covered by the patient.
What is PEI?
The PEI (Patient Episode Initiation) as included in an account is a government approved collection fee for the costs associated with the collection, handling and reporting of tests.
The PEI is similar to an administration fee. It covers specimen containers, needles, tubes, sharps containers, referral and report paper, our courier service and Doctor’s Service Centre, instruments, gloves, hand sanitiser, the staffing of our laboratories.
It was just a simple blood test
Pathology is a complex service which has many different steps in order to complete the testing. After the blood has been drawn it goes through several testing at our Laboratory to produce a result for your doctor.
Capital Pathology direct-bills accounts for International Students insured by OSHC Allianz and Medibank Private.
Pathology costs for International Students and any children of International Students are for the account of the individual patient. Patients 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.
Other International Patients
Pathology testing for International Patients other than students and any children of International Patients are billed at AMA (Australian Medical Association) rates for the account of the individual patient.
Patients with health insurance may claim any rebates as per the cover from the insurer.
Please be advised that refunds may incur an administration and processing fee of $40, which will be deducted from the refundable balance.