Asking about fees

Health costs can be confusing. Fees vary between practices, appointment types and health professionals, and Medicare and private health insurance may cover some of the cost but not all. The best way to avoid surprises is to ask before you agree to a service.

This is general information, not financial advice. We don't publish fees or rebates because they change and differ between practices.

Your right to information about costs

The Australian Charter of Healthcare Rights, from the Australian Commission on Safety and Quality in Health Care, says you have a right to receive information about services, treatment options and costs in a clear and open way. Asking about fees is normal, and good providers expect it.

Key terms

• Fee: what the provider charges.
• Medicare benefit or rebate: what Medicare pays for an eligible service.
• Bulk billing: the provider accepts the Medicare benefit as full payment, so you pay nothing for that service. See bulk billing explained.
• Out-of-pocket cost (gap): the difference between the fee and what Medicare and any private health insurance pay.

Questions to ask a GP practice

• Will this appointment be bulk billed?
• If not, what's the fee and what will I get back from Medicare?
• Is the fee different for longer appointments, after hours or telehealth?
• Are there extra costs, such as for procedures, dressings or forms?
• Do you charge for missed appointments?

Questions to ask a specialist

When your GP refers you to a specialist, ask the specialist's rooms:

• What is the fee for the first appointment, and for follow-ups?
• How much will Medicare pay back?
• Are there likely to be extra costs, such as tests or procedures?
• If I need surgery, what are the likely costs, including the surgeon, anaesthetist, assistant and hospital?
• Can I have a written estimate?

If cost is a concern, tell your GP. Fees vary between specialists, and your GP may know of other options. Some public hospitals run outpatient clinics. See referrals and specialists.

Private health insurance

If you have private health insurance, check with your insurer what's covered. Ask the provider whether they have an arrangement with your insurer, and ask your insurer about any gap.

Getting it in writing

For larger costs, ask for a written estimate. Read it carefully and ask questions if anything is unclear.

If costs are a barrier

• Ask whether the practice bulk bills, or bulk bills certain patients.
• Ask about payment plans.
• Talk to your GP about options.
• For urgent, non-life-threatening problems, Medicare Urgent Care Clinics are bulk billed.

If you're unhappy with a bill

Talk to the provider first. If you can't resolve it, see health complaints.

Practical ways to manage health costs

• Ask about bulk billing and fees before every new service.
• Keep receipts and check your Medicare claims, which you can see in your Medicare online account.
• If you or your family have high out-of-pocket costs for Medicare services in a calendar year, look into the Medicare Safety Net, which may increase the benefit you get back once you reach a threshold. Families and couples need to register as a family to combine their costs. Check Services Australia for current details.
• If you hold a concession card, mention it, because some practices bulk bill concession card holders.
• Ask your GP whether generic medicines are suitable, and talk to your pharmacist about medicine costs and the PBS Safety Net.

Waiting times and public options

Waiting times to see specialists vary widely by specialty, location and urgency. Public hospital outpatient clinics may see patients at no cost, but often have longer waits for non-urgent conditions. Private specialists may see you sooner, but usually charge fees above the Medicare benefit. If your condition gets worse while you're waiting, go back to your GP, who may be able to ask for an earlier appointment. Ask your GP which option makes sense for your situation.

Your privacy

Health information is sensitive, and Australian privacy law places obligations on health services about how they collect, use, store and share it. Practices should have a privacy policy explaining this, and you can ask to see it. You generally have a right to access the health information a practice holds about you, although a practice may charge a reasonable fee for providing copies. If you're concerned about how your information has been handled, raise it with the practice first. The Office of the Australian Information Commissioner (OAIC) handles privacy complaints about many health services.

Finding reliable health information

There's a lot of health information online, and not all of it is accurate. Some tips:

• start with trusted sources such as healthdirect, government health departments and well-known health organisations;
• check who wrote the information, when it was last updated and whether it applies in Australia;
• be cautious of sites selling products or making dramatic claims;
• bring what you've read to your GP and ask what applies to you.

On this site, we link to official sources for every factual claim and note when information was last reviewed. Rules about Medicare, telehealth and programs can change, so always check the source pages.

If you're helping someone else

Many people book and attend appointments for a child, partner, parent or friend. If you're a carer:

• ask the person (if they're able) what they want to discuss, and write it down together;
• bring their Medicare card, list of medicines and any notes about changes you've noticed;
• let the GP speak directly to the person where possible, and add your observations;
• ask whether the practice needs written consent for you to receive information on the person's behalf.

Carer Gateway, an Australian Government service, offers free support for carers, including information, counselling and respite. Looking after yourself matters too, so mention your own health at your next appointment.

Words you may hear

• Schedule fee: the fee the government sets for a Medicare service, used to calculate the Medicare benefit.
• Rebate or benefit: what Medicare pays for an eligible service.
• Gap: the difference between the fee and what Medicare (and any insurer) pays.
• Informed financial consent: when a provider explains likely costs before treatment so you can agree knowingly.

Ask the provider to explain any term you don't understand.

Veterans and DVA cardholders

If you hold a Department of Veterans' Affairs (DVA) card, tell the practice when you book and bring your card. DVA arrangements for health services differ from standard Medicare arrangements, and many providers bill DVA directly for eligible services. Ask the practice how it handles DVA patients. DVA's own website and its phone line can explain what your card covers. MyMedicare registration is also open to DVA Veteran Card holders, according to the Department of Health, Disability and Ageing.

How we keep this guide up to date

Medicare rules, government programs and service arrangements change from time to time. We review this guide against the official sources listed below and update the date at the top of the page when we check it. If something has changed, or you spot an error, please let us know through our contact page. Before you rely on any detail, especially eligibility rules, check the official page linked in the sources, or ask your practice or Services Australia directly.

Use the visit planner

Our free visit planner turns this advice into a short, printable list. Choose the kind of appointment, add your own questions, and it lists what to bring and what to ask, always including a question about billing. Everything stays in your browser and nothing is sent to us. It's a planning aid only, not medical advice.

Key points

• You have a right to information about costs.
• Ask about fees and Medicare rebates before you agree to a service.
• Ask specialists about all likely costs, and ask for a written estimate.
• Check private health insurance cover with your insurer.
• Tell your GP if cost is a concern.