We understand that there are heaps of questions behind a medicare system that OSHC students and international visitors may not be familiar with when it comes to GP consultations. Rest assured it is not as complex as you might think.

1. Medicare covers the majority of all GP and pathology services. Medicare cards are given to PR and Australian citizens.
2. Private health insurance is for International visitors and OSHC students to make sure they are covered for any basic health needs.
3. When you come in for a consult as an international visitor or OSHC student, your private health insurance covers the cost of your GP visit usually up to the MBS rate. On higher levels of cover, it might cover more.
   • Some clinics recognize this and charge extra to the OSHC insurances, but usually, it’s international patients or students that end up paying that extra money.
   • We DO NOT charge any out-of-pocket expenses and only charge the MBS rate.
   • If your GP clinic has direct claiming from the HICAPS terminal then you can claim directly from the Insurance. In this instance, you won’t have to pay any money upfront. If a GP clinic is old school and doesn’t have direct claiming, then you will need to pay upfront and hope that your insurance pays the full amount (indirect claiming). In this instance, depending on the item numbers placed and how much they charged you- you may not get the full amount back.

For example

1. 1. • Clinic 1 Direct claiming (Woodville Rd Medical and Dental).
        1. After your consult, you would wipe your private health insurance card on the terminal.
        2. That is it. Job all done. Simple as that. No money exchanged.
      • Clinic 2 Indirect claiming (Generic other clinics).
        1. After your consult, the doctor will let you know which item it is and how much you will need to pay. Now, this is where it gets tricky.
        2.  If it’s a Level B consult, and you for example you are charged $70 then you must pay $70 at the counter.
           1. You will then have to send the claim to your insurance.
           2. But insurances typically only pay the MBS rate which is below (item 23 – $38.75)
           3. Which means they will only reimburse you $38.75 in a few days or a week. You would be out of pocket by $31.25.

Well, how could you know what the item was and whether there would be a gap? Who do you complain to that you had to pay $31.25? If you had asked how much the consultation was before, then you have gotten the response, “It depends on the duration of the consultation” (Scroll down for more information about consult duration and item numbers). Couldn’t he have charged me a higher-level consultation instead of a lower-level consultation? (medicare audits the time and would be illegal).