What Is Bulk Billing?

In Australia, bulk billing refers to healthcare services provided at no cost to patients. Instead, the doctor or service bills Medicare directly and accepts the Medicare benefit, or rebate, as full payment for their service to you.

As the Australian government’s Department of Health and Aged Care explains to Forbes Advisor, bulk billing is a billing arrangement that occurs under the Medicare Benefits Schedule (MBS).

“A bulk billed service is one where the medical practitioner accepts the relevant MBS rebate as full payment for the service, and the patient does not have any out-of-pocket expenses,” a spokesperson says.

“In contrast, a patient who is not bulk billed will pay for the cost of the private service and then claim their Medicare rebate for the service.”

Medicare is able to fund the rebates as the Australian government pays for Medicare through the Medicare levy, and Australian taxpayers pay 2% of their taxable income towards the levy.

As the government-funded service Health Direct explains, it is called bulk billing because the GP practice bills Medicare in ‘bulk’, that is, a collection of consultation services are billed to Medicare at the same time.

Bulk billing vs mixed billing

Increasingly in Australia, more doctors and health practitioners are charging their patients on a “mixed billing” schedule.

Mixed billing simply means that patients are required to pay a ‘gap payment’ for appointments, which is the difference between the practice’s fee and the medicare rebate, rather than the practice absorbing the cost. This gap payment varies from practice to practice.

If a doctor doesn’t offer bulk billing or mixed billing, you will have to pay the full service fee; however, you still may be able to receive a Medicare rebate by making a claim.

Before you see a doctor or health practitioner, it’s important to ask whether they do bulk bill; if there will be any out-of-pocket costs for you to be aware of; and, if they don’t bulk bill, what you may be able to claim from Medicare as a rebate.

Some practices may bulk bill for certain appointments or treatments, but not others, or may still offer bulk billing for certain patient groups (such as those carrying a concession card or pensioners).

Commonly, if a practice does offer bulk billing, it would usually cover the visit to a GP or specialists, including telehealth appointments; tests and scans like x-rays and pathology tests; and eye tests performed by optometrists.

The best way to find out if a practice bulk bills is to ask directly. This way you will understand if there are any conditions—such as appointments only being bulk billed within certain hours—any out-of-pocket costs, or any eligibility requirements.

You can also use the Health Direct website’s health service finder, which allows you to sort results via the type of service you are looking for, whether or not they bulk bill, and the proximity of the service provider to your location.

Why do doctors choose not to bulk bill?

Some doctors have always chosen to not bulk bill, while many others have been altering their billing methods in the past few years. In fact, it’s expected that the national bulk-billing rate may plunge to as little as 30% within two years, as per The Australian’s report.

This prediction follows statistics from Primary Care Business Council, which reveals that the rate of the most common type of GP visits that are bulk-billed has dropped to an average of 61% across its 500 clinics, a 12% decline from two years ago. (Medicare claims the average annual rate of bulk billing is actually 78.1%).

A Department of Health and Aged Care spokesperson states that GPs and other medical and health services operating practices “as private businesses” and are therefore “free to determine whether they bulk bill some or all their patients or charge a co-payment”, which is why the percentage of bulk billing is dropping.

“To support GPs who bulk bill their patients, the government provides a bulk billing incentive for bulk billed services provided to Commonwealth Concession Card holders and children under 16 years of age,” the spokesperson continues.

But it seems the government support and initiatives are not enough in the current climate, with news reports claiming the country’s “bulk billing crisis” has seen general practitioners close their doors due to an unsustainable funding model–along with those passing full fees on to their patients.

Ultimately, doctors are choosing to no longer bulk bill because the Medicare rebate they receive is no longer enough to cover their costs.

The future of bulk billing

As dire reports of the bulk billing crisis continue, many Australians are left wondering what the future of bulk billing looks like. Will all doctor and specialist visits incur a full fee with no Medicare rebate in the years to come?

According to a Department of Health and Aged Care spokesperson, that won’t be the case–thanks in part to a new fund being established to improve Australia’s healthcare system.

“The Strengthening Medicare Taskforce, chaired by the Minister, will identify the best ways to boost affordability, improve access and deliver better support for all Australians, through the $750 million Strengthening Medicare Fund,” the spokesperson told Forbes Advisor.

“The Taskforce is due to report at the end of 2022.”