Patient Billing Information
SEALS is a not-for-profit public pathology organisation. As such, there are no out of pocket expenses for services covered by Medicare, for privately referred non-inpatients or insured inpatients. There are however, some tests (often specialised) that are not covered by Medicare Australia, the Department of Veteran Affairs or Private Health Funds. This means that the patient will be responsible for the full cost of those tests. These tests are identified on an invoice with the following comment directly above the single test item “Above item cannot be claimed on Medicare”. A list of these tests and their costs can be found by viewing ‘tests not covered by Medicare’.
As a major referral laboratory, SEALS undertakes testing on behalf of many other pathology organisations. Therefore, in some instances, patients may receive an invoice from SEALS, although their sample may have been collected by another pathology organisation.
Medicare Eligible Patients
As a private admitted patient of a recognised hospital, your invoice will be set at 100% of the Medicare schedule fee for all tests covered by Medicare. This means that you will be able to claim 75% from Medicare and 25% from your Health Fund. If you are not enrolled in a Health Fund you will be responsible for paying the 25% gap. Where specific agreements have been made between the SEALS and your Health Fund (MPPA Agreements) your account can be sent directly to the Health Fund for payment. If you would like to know whether your health fund participates in these agreements, you can contact the Billing Services Centre.
As a private non-admitted patient, your invoice will be set at 85% of the Medicare schedule fee for all tests covered by Medicare. Patients will be bulk billed if they have signed a Medicare Assignment form at the time of service. Patients will be asked to provide their current valid Medicare Card as proof of eligibility.
All patients who have not signed a Medicare Assignment form at the time of service will receive an invoice. This invoice can be submitted to Medicare for payment.
As a public admitted or non-admitted patient, any pathology testing undertaken will be done at no cost to the patient. If you feel that you have received an invoice in error, please contact the Billing Services Centre to discuss further.
Billing question and answers
Veteran Affairs Gold Cardholders
If you are a Gold Cardholder, all Medicare eligible pathology tests can be claimed directly from the Department of Veteran Affairs. Please provide this number prior to admission or present your card at a SEALS Collection Centre during an outpatient visit. If you receive an invoice from SEALS and believe the services should be covered by Department of Veteran Affairs, please contact the Billing Services Centre to discuss further.
If your pathology tests relate to Workcover or insurance claims, you will be required to pay SEALS for these tests. Once payment is made, you can claim directly from the insurance company by presenting your SEALS invoice and receipt.
Medicare Ineligible Patients (e.g. Overseas visitors/students to Australia)
If you require pathology services as an inpatient (admitted to hospital), Medicare Ineligible patients (patients who do not possess an Australian Medicare Card/DVA Card) are required to pay upfront. If this has not occurred, an invoice will be sent to you and payment is required in 30 days. SEALS Pathology cannot send the invoice to a health insurance company for payment, this is the responsibility of the patient.
If you are a Medcare Ineligible patient and require pathology services as a non-admitted patient (outpatient) the minimum out of pocket expense for pathology tests peformed for each collection, regardless of the number of tests requested, is $266. This payment is required prior to collection. Payment can be made via cash, EFTPOS or credit card. If the total cost of tests requested at a single visit totals more than $266, an invoice will be issued for the balance and payment of this invoice is required within 30 days. These pathology costs are claimable through Overseas Students Health Cover (OSHC), travel or private health insurance.
The following patients are exempt from these pathology costs (these patients need to be indentified on the request form by the requsting clinican):
- Overseas Renal Transplant Donor
- ROMAC (Rotary Oceania Medical Aid for Children) sponsored patients
Please mail the following :
a) Pathology payment advice of your invoice (bottom section) and
b) All cheques and remmitance advices
c) Any payment advices from Medicare and/or health fund.
PO Box 970
Kogarah NSW 2217
Phone the Billing Services Centre on (+612) 9113 1120
. Credit card phone facility is available from Monday - Friday 8:00am - 4:00pm (Public Holidays excluded). Only Mastercard and Visa cards are accepted.
Prior to calling please have the following details ready, which can be found on the bottom right hand corner of your pathology invoice:
a) Invoice number
b) Patient MRN
c) Reference number
Please email your request for banking details to: NSWPATH-SEALSRevenue@health.nsw.gov.au
Your email request must include the following details, which can be found on the bottom right hand corner of your pathology invoice:
a) Invoice number
b) Patient MRN
c) Reference number
Payment in cash, cheque or credit card can be made at the cashier of the hospital. Please supply a copy of the invoice to the cashier, along with any Medicare/Health Fund payment statements. This is to ensure the correct invoice is cleared and that any rejections processed by Medicare/Health Fund can be reviewed by a Revenue Officer in the Billing Service Centre and dealt with appropriately.