Understanding Medical Insurance (incl. Medicare)

At CBD Doctors Melbourne we provide health care to patients:

with Medicare;
without Medicare but with health insurance;
people with travel insurance that covers health; and
people without any health insurance and with the intention of meeting our patients’ needs.

All medical services including doctor’s consultation fees and pathology (laboratory) and radiology (x-rays and other images) attract fees. Please note we are we are a private billing practice and you will required to make full payment at the time of your appointment. You will be required to get a reimbursement from your insurer if it is applicable to policy.

In general, there are two types of medical appointments and visits:

1. Hospitals
2. Out of hospitals (outpatients)

There are two types of hospitals in Australia – public (run by the government) and private (run by different professional groups).

Australian Permanent Residents and Citizens (Medicare card holders)

If you are a permanent resident and/or citizen in Australia, all of your health care services will be covered if you are admitted to a public hospital. (public hospitals are funded by states).

If you have a private health insurance, you will need “hospital cover” to have your health costs covered by a private insurance if you are admitted to a private hospital. Despite health insurance, you may be asked to pay “out of pocket fees” for doctors’ consultation and procedure. Keep in mind that there may be a few doctors involved in your care and that there may be a few procedures done at the same time. Some procedures like liposuction may not be covered by any health insurance and you may need to pay the full fee for it.

Please note visits to a general practitioners or a specialist (outpatient clinic/private rooms) ARE NOT COVERED by any private health insurance. You are required to pay a full fee on the day of your appointment and send your receipt to Medicare for reimbursement. That means that you will have out of pocket cost.

Temporary Residents, Visitors and Students Visa Holders

You will need to have a private health insurance. Please note this is different insurance from Medicare, but majority of them would cover the same services and procedures. The cost that they would cover would be equivalent cost to Medicare.

You will need to see the wording of your policy to find out what your policy cover:

- Some policies wouldn’t cover visits to general practitioners.
- Some would have a “cap “what they would cover
- Some policies would ONLY cover visits to general practitioners (out of hospitals)
- Some policies would cover ONLY emergencies
- Some would cover ONLY hospital admissions.
- Some policies would cover only $50 towards the cost of medications.
- If you need pregnancy cover, that will have to be specified in your policy.
- All children’s immunisation is covered by the Australian Immunisation program, which means that majority of vaccines are free. Please ask at the reception.

Travel insurance from overseas may not cover everything. You would need to pay the costs of consultations, medications, tests (pathology and radiology). You will need to collect all your invoices and send them to your travel insurance company. These policies are usually valid for 12 months, and if you need to get an extension, you may need to go back. Check with your insurer.

Transition From Temporary To Permanent Visa

If you are transitioning from temporary residence to permanent residence, only a certain bridging visa would give you an access to Medicare (e.g. partner’s visa).

Reciprocal Health (New Zealand and UK)

If you recently came from countries that have “reciprocal arrangement” with Australia, like from New Zealand, or UK, you will need to submit your documents to Medicare. It may take 6+ weeks to receive your card. Your Medicare cover should start from the date you applied.

Lodge your receipts with Medicare for reimbursement of your incurred costs once you receive your card.

Newborn Australians

If you are permanent resident or citizen of Australia, you and your family will have access to Medicare. Please note newborn children are not automatically added to your card. You need to notify Medicare that you have another family member. It may take ever 3-4 weeks to get a new name on the card, but your newborn can still visit doctors, have tests done. In some cases, you will be required to pay for the cost, but once your baby is added, you will be able to reimburse all of your costs – from birth. Immunisation of children is free. There are some vaccines that are not covered by the Government: e.g meningococcal B vaccine in Victoria.

Summary:

Health system in Australia is complex. Individual health cover would depend on your visa status and policy that you have. Please be aware that some services that you need, may not be covered by your policy. Read your policy and call your insurer if you need to ask questions. Our reception can not answer questions about your policy – only your insurer may be able to.

Bills for doctors’ consultations, medications and radiology services must be paid on the day of service. Bills for laboratory (pathology) may not be issued on the day of service and need to be paid upon receipt of the bill. Once you pay your bill to a pathology, you need to send the receipt to your insurer.

Another option is that you give details of your insurer to your doctor or a person taking your blood. They can record details of your insurer on the referral and some of the insurers would pay directly to a pathology service.

Medicare and Hospitals (Australian Permanent residents and citizens)	Private insurance for temporary residents (working holiday visa, student visa and temporary working visa)	Private insurance for Permanent residents and citizens	Newborns to Australian permanent residents and citizens
Medicare Covers majority of services outside of hospitals	Hospital cover (could be only public hospitals, only private or both please check with the insurer)	Hospital cover admissions to private hospitals (the most important cover)	Medicare covers majority of services
Specialist visits	Hospital cover may include both public and private hospitals	Specialist fees in private hospitals	If a newborn is not added onto the card- all costs need to be paid at the time of appointment
GP visits	GP visits (not every cover- please check with the insurer)	Procedures in private hospitals	Public hospital cover- unlimited
Medications- only proportion	Medications (only some)		Medications – proportion of the cost
Public hospitals	Specialist – not all		General practice
Public hospitals	Limited cost of some medications		Pathology Radiology
Proportion of the cost of pathology and radiology	Proportion of the cost of pathology and radiology	Proportion of the cost of pathology and radiology

If you are coming to the CBD Doctors Melbourne as a patient, please make sure you bring your membership card (not an email from the insurer) with you. It will be easier to pay your fees.

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