Can You Bulk Bill After-Hours Clinics in Australia?

It is late at night, and someone at home is not feeling well. The last thing I would want is to worry about the medical bill. Many Australians find themselves in this situation and ask, "Is it possible to bulk-bill an after-hours doctor visit?"

The answer is that, in general, bulk billing after-hours is achievable, but not everywhere or in all circumstances. Transparency is key to 13CURE's bulk billing policy for all after-hours services. Whether your visit will be bulk billed depends on a few factors: the type of service you choose, the time of your call, and your Medicare eligibility.

After-hours services cover the gap between your regular GP and the hospital emergency department for health problems that can't be waited for until the next day but are not severe enough to go to the emergency room.

To understand how after-hours billing works, we should first understand bulk billing.

Bulk billing is when your doctor sends the bill directly to Medicare. The doctor accepts the Medicare rebate as full payment; therefore, you are not required to pay out of pocket. To do this, you need to have a valid Medicare card.

On the other hand, bulk billing is not compulsory. Some doctors may charge private fees above the Medicare rebate, meaning you must pay the difference. This additional payment is known as the gap fee or out-of-pocket cost.

How Bulk Billing Works for After-Hours Services

The Australian Government is aware that people need medical care even at night or on weekends, not only when clinics are open during their regular hours. Medicare considers after-hours to be:

• Before 8 am and after 6 pm on weekdays
• After 12 pm on Saturdays
• Whole day on Sundays and public holidays

Doctors working during these hours are entitled to a higher rebate via the Medicare Benefits Schedule (MBS). This compensation is for their extra operating costs, such as working at night, on weekends, or on public holidays. Even if the higher rebate facilitates bulk billing for some providers, their decision remains whether or not to do so.

What Affects Whether a Service Is Bulk Billed

Several factors can determine if your after-hours visit will be bulk billed.

1. Time and Day of Appointment:

• Time and Day of Appointment:The later it is, the higher the rebate a doctor gets. Consequently, bulk billing is more prevalent during overnight hours or on weekends:
• Evening (6 pm-11 pm): Some clinics provide bulk billing during these hours.
• Late night (11 pm-7 am): The rebate for midnight hours is the highest; thus, several home doctor services bulk bill these calls.
• Weekends and public holidays: Because they are considered after-hours for the whole day, higher rebates are applied, and therefore, bulk billing is more frequent.

2. Type of Service

Cost differences arise between telehealth and home visits.

• Telehealth: Consulting via video or phone costs less, so it's usually lighter on the budget for bulk billing. However, one typically needs an in-person visit with the same GP within the last 12 months to be eligible for a Medicare rebate. This is to ensure continuous care.
• Home Visits: The cost of sending a doctor to a patient's home is higher, but many after-hours national services may bulk bill eligible patients. These services receive higher Medicare rebates for such visits, especially during late-night hours.

3. Location and Type of Clinic

Your location also affects where you can be bulk billed.

• Typically, national providers bulk bill as they are GPs' partners in different locations across Australia.
• Minor local clinics might ask you to pay a private fee to cover their limited operating costs.
• Urban areas are relatively well-equipped with bulk-billing venues, compared to the countryside, where costs are generally higher and doctors are in short supply.

We extend our commitment to bulk billing in regional locations, ensuring rural patients are not disadvantaged.

4. Eligibility and Concession Cards

Your situation is critical too.

• A valid Medicare card must be bulk billed.
• Suppose you are under 16 or hold a Pensioner Concession Card or a Health Care Card, the likelihood of your visit being bulk billed increases. The government gives doctors an additional incentive if they bulk bill these groups.

Telehealth vs Home Visits: What's Covered After Hours

When your regular GP is unavailable, you typically have two main after-hours options: telehealth or a home doctor visit.

Telehealth Appointments: Telehealth allows you to see a doctor via video or phone, without leaving your home. It is suitable for minor or manageable health cases that do not require a physical examination, such as colds, skin rashes, and UTIs. It can also be used to get repeat prescriptions or follow-up advice.

After booking, you will be sent a link to securely join your session. The doctor will listen to your symptoms and, if necessary, issue an electronic prescription (eScript), a medical certificate, or a referral.

MOST after-hours telehealth services are bulk billed for patients who meet the criteria. However, some private platforms outside Medicare charge a fixed fee, so always confirm this before booking. While the doctor's visit is covered, it is essential to understand the cost of medication vs consultation fees.

Home Doctor Visits: When moving around is difficult (for instance, if you are nursing sick children, caring for an elderly parent, or someone with mobility problems), home visits are just right for you.

During a home visit, the doctor will appropriately examine you as if you were at a clinic. They may provide you with limited medication on the spot, and will send a report to your regular GP the next day to keep the record of care flowing.

Several national home doctor services bulk bill patients with valid Medicare or Department of Veterans' Affairs (DVA) cards.

Always be aware that no service will bulk bill you automatically. In a flash, you can check to protect yourself from bill surprises. To access these rebates, you must be ready to provide Medicare details during booking.

If a clinic is not bulk billing, you are expected to pay the full private fee upfront, and you can later claim a part of it back from Medicare. Some out-of-pocket expenses will still be in place.

You can get your rebate:

• Immediately: After the transaction, several clinics can process claims immediately.
• On the Internet: Through myGov or the Express Plus Medicare app.
• Face-to-face, last option: At a Services Australia Centre.

Please note that some private telehealth platforms do not involve Medicare at all. If this is the case, you must pay a flat fee, and no rebate can be claimed. Always ensure the cost is known before your appointment.