Medicare and your account

When your doctor sends your specimen to TissuPath for assessment by one of the pathologists, they are requesting an additional specialist medical opinion and so you may receive a separate account from TissuPath.

Medicare in a ‘nut-shell’

Billing for pathology is based on a fee structure designed by Medicare whereby different ‘procedures’ or tests are allocated a ‘schedule fee’. Medicare will rebate (or reimburse) 75% of this schedule fee. The difference between the Medicare rebate amount and the account total is variably covered by private insurance (for inpatient procedures only) with anything not covered often considered an ‘out-of-pocket‘ expense and referred to as a ‘gap‘.

Your account

Your TissuPath account and any ‘out-of-pocket’ expense is dependent on several things:

  • The type of procedure – Number of specimens assessed and the ‘complexity’ of those specimens (the ‘complexity’ level of a specimen roughly equates to the amount of time and materials required for thorough assessment and reporting).
  • Your private insurance.
    • If you belong to one of TissuPath’s affiliated health funds (click here to see list), we will bill your health fund directly so you will not receive an account and will not incur any out-of-pocket expense.
    • If you belong to an alternative insurance provider, you will need to claim reimbursement directly from your fund and may incur an ‘out-of-pocket’ expense.
    • If you are uninsured you will be responsible for any ‘gap’ payment above the Medicare rebate.
  • Where you had your procedure – Private insurance will only cover inpatient procedures (hospital or accredited day care facilities)

Commonwealth Aged Pensioners and DVA gold card holders are billed directly through medicare (‘bulk billed’) and will not see an account

The administration team at TissuPath are happy to discuss your account or any account enquiries you may have and can be contacted on (03) 9543 6111.

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