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 one it’s worth knowing what you’re in for. So in ‘Are Blood Tests Free in Australia?’ we list reasons why you could have your request for rebate declined by Medicare, and provide a link to the tests that are funded by the Australian Government, Medical Benefits Scheme.
What to Expect on the Day
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 testing hormones, you will need a laboratory test Referral (request) 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.
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, (more 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.
Are Pathology Tests Covered by Medicare?
The Australian Government funds a wide range of pathology tests via its Medicare Benefits Schedule (MBS). Before running out to request one, it’s worth knowing the following. You are only eligible for a rebate for 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.
What is an example of a blood test that won’t likely be approved for a rebate?
- 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.
- And finally, there are also some limits on the number of rebates allowed for the same blood test over a year. So keep your own notes or diary of the journey.
The cost of the test 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.
Bare in mind, some of the equipment used, like the Star Trek sounding ‘ultra performance supercritical fluid chromatography tandem-mass spectrometer’, can cost more than the average home.
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 “Are blood tests Free for me?”
And remember, TestoChecker® now offer a wider range of at-home, contact free, test kits 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.