Will my private health fund cover blood test costs?
Will Medicare pay for my blood test?
How much do blood tests cost?
Are blood tests free in Australia?
Before running out to request a pathology test it’s worth knowing what you’re in for becuase the reality is, medical specialists can charge whatever they wish. Some of the advanced methods being used by labs nowadays, like the Star Trek™ sounding ‘high-performance liquid chromatography‘, used for testing levels of neurotransmitters, like dopamine and seretonin, dont come cheap.
In ‘Are Blood Tests Free in Australia?‘, we list reasons why you could have your request for rebate declined by Medicare, and provide links to the tests/sevices you can, and cannot claim for on the Medicare Benefits Schedule (MBS).
N.B. COVID19 testing – If you are looking for information related to COVID19 coronavirus testing, the best place to get it is from the official source – NSW health Government website.
How do I get a Blood test in Australia?
First stop is the local medical center or your family GP. Why? Because to test any human biological specimen in an [accredited] Australian laboratory, this is compulsory. Whether it be to check the health of the kidneys, liver, vitamin D levels or even hormone testing, you will need a laboratory test Referral Form.
OK, so you have that referral form, now what? Doctors are rarely willing to perform the ‘blood draw’ themselves as this is a specialist procedure. Normally you would attend a pathology collection centre, which is sometimes located in the same complex where the doctor practices.
After confirming your referral details and identification, and asking some basic questions about how you feel, a tourniquet will be placed around your arm and a needle inserted into your vein.
Up to 30mil of blood is collected, which despite sounding like a lot, is replaced by the body in no time. The vial(s) are then sent to a pathology laboratory for testing.
You will be advised to maintain pressure on the needle site for 5 – 10 minutes to prevent bleeding and finally a sticking plaster is applied. Bruising may appear at the site where the blood was taken. This is more common in people with a blood circulatory condition.
Private health insurance can sometimes cover the cost of blood tests, but that depends on a couple of things…
Does Your Private Health Insurance Cover Blood Tests?
Private health funds do sometimes cover the cost of blood tests, but this depends on whether you receive treatment as an inpatient or outpatient.
Included with inpatient hospital cover, all standard pathology tests will be funded by your private healthcare insurer. If your GP recommends that you undergo a blood test as an everyday outpatient – you won’t be covered.
No need to worry though as outpatient services are covered by Medicare**, in most cases.
How Much Does a Blood Test Cost in Australia?
Here are the results of some random enquiries made by TestoChecker. (updated Jan’2022). Remember that potentially there are two costs, the Doctor first, and then later the private pathology company. They usually won’t charge until their work is done.
We’ll start by looking at the easier to obtain information. How much will it cost to get that referral/request form from a GP for the blood test?
– What will a Blood Test Cost in Queensland, Brisbane, CBD:
Private Medical practice, i.e. “private billing practice”.
- No bulk billing.
- Cost of consult approximately $80 (includes lab referral form required for blood test)
- Medicare rebate $40
- Pathology is usually free to Medicare eligible patients with referral from GP.
People without Medicare will usually have to pay the full cost of the blood test in addition to the cost of Doctor’s visit, as above.
– What will a Blood Test Cost in Perth, Western Australia, CBD:
Private Medical Practice, i.e. “private billing practice”
- No bulk Billing.
- $70 for consultation and pathology request/referral form.
- $40 rebate from Medicare.
- Pathology lab may bulk bill for Medicare eligible patients.
As mentioned up top, in Australia a blood test requires a pathology request form from a Medical Practitioner (GP), and a person without Medicare will usually be charged by both the General Practitioner, as well as the Private Laboratory firm selected by that practitioner.
– What will a Blood Test Cost in Byron Bay, NSW:
Private billing Medical Practice, i.e. usually will not Bulk Bill through Medicare
- No bulk billing
- First consult $122,
- Medicare rebate $75
- Gap $47
- The Pathology request form will need to be taken to a specified Pathology collection centre, which will charge a fee
To obtain private pathology test-cost-estimates isn’t easy. Generally a blood test in Australia will cost between AUD$80.00 and $300.00 depending on how many elements, or assays are included. That will depend on the reason for the test, and as frustrating as it may seem, you may not find out the pathology test cost until it’s done.
How much will it cost to get a blood test in Sydney? [To be confirmed]
Covid19 virus Testing is Different, Why?
This does not include covid19 testing due to it being subsidised by Australian government funding.
Anyone seeking to get tested for covid19 and doesn’t have Medicare will receive it free of charge should they use the publicly available clinics in their State or Territory. Wait times at many of these clinics have been disgraceful, it is advised to do research before joining one, and take your toothbrush!
Give Me Some Good News !
The good news is that Medicare can help cover the cost of blood tests in many situations. Which tests Medicare covers, (link below) and which it does not, can be handy information to have. It may save you some valuable time at the very least.
Let’s focus on the sole provider here, Medicare.
Which Pathology Tests are Covered by Medicare?
The Australian Government funds a wide range of pathology tests via its Medicare Benefits Scheme (MBS). Before running out to request one, it’s worth knowing the following. You are only eligible for a rebate on a blood test listed on the MBS (link above) if:
- The practitioner is registered with Medicare.
- A valid medical reason is cited for the blood test.
- The lab performing the testing is a Medicare approved laboratory.
- The type of test has been approved by Medicare for funding. i.e. It can be found on the MBS list.
Try using the Medicare Benefits Schedule, pathology test eligibility search tool to see how much you can expect to be left out of pocket.
Which Pathology Tests are NOT Covered by Medicare?
- Let’s say a blood test is requested by the court, or by an insurance company assessor or similar. In these cases a rebate would likely be refused, as this is not in line with the purpose of the medicare reimbursement act.
- Another example would be if a person needed to undergo blood test results required for making an application for employment.
- Or where a person is requiring blood work which is either related to overseas travel, or taking place in a foreign country.
- Finally, there are limits on the number of rebates allowed for the same blood test over a 12 month period. So keep your own notes or diary of the journey.
The cost would be determined by the type of test required and there are many. Tip: In cases where a private health fund is contributing, be sure to ask the referring doctor what the expected out of pocket expense, or gap, will be. They should be able to at least provide an estimate. In the aforementioned rare cases a blood test is not covered, the test cost can range between AUD $150 – $1000.00 for the more advanced tests.
You can take a look for yourself at the list of services the MBS does not cover, via the link here on this page
What’s the take-away?
Don’t expect a free ride as you head down the pathology path. Do some research first using the Search tool provided here, but also ask your doctor for advice and don’t be afraid to smile and ask “Pardon me, are your blood tests free?”
And remember, TestoChecker® now offer a at-home, 100% contact free hormone testing than ever before.
Author: Guy Saywell
TestoChecker Hormone Test Kits ®
Address: Suite 1A, Level 2, 802 Pacific Highway,
Gordon, NSW, 2072.
*In rare cases test costs are more than the rebate. In this scenario the difference must be paid by the patient.
*Medicare will not provide cover for international visitors, please contact your health insurance provider for more information.