Medical billing
Australia — Medicare, bulk billing, the MBS and informed financial consent
NationalAUDerived or secondary source
Australia
- Rule id
- medical.au
- Version
- 1.0.0
- In force from
- February 1, 1984
- Last read against its sources
- August 5, 2026
- Countries bound
- Australia
In plain language
What this regime says.
Medicare pays a benefit against the Medicare Benefits Schedule fee for each item. Practitioners may charge above it, and the difference is the gap — unless they bulk bill, in which case the assignment of the benefit is full payment and nothing further may be charged.
Who is covered
Medicare-eligible people treated in Australia, and privately insured patients facing gaps.
What you get
No further charge for a bulk-billed service; written itemisation by MBS item number; and a free ombudsman for private health insurance disputes.
Where claims go wrong
- Signing a bulk-billing assignment and then paying a later "gap" invoice for the same service.
- Asking the hospital about costs but not the anaesthetist, who bills separately and is where most surprises come from.
- Assuming gap cover applies because the hospital is in the insurer's network. Participation is per practitioner.
Authority
Every citation,
with its pinpoint.
A claim that cites “EU law” gets filed. A claim that cites Article 7(1)(c) gets answered. These are the exact coordinates this entry rests on.
- Health Insurance Act 1973 (Cth), s. 20AHealth Insurance Act 1973 (Commonwealth of Australia)URL verified 2026-08-05s. 20A — assignment of a Medicare benefit ("bulk billing"), under which the assignment operates in full payment and satisfaction of the medical fees for the service
- Private Health Insurance Act 2007 (Cth)Private Health Insurance Act 2007 (Commonwealth of Australia)URL verified 2026-08-05Provisions governing benefits, gap cover schemes and the rules insurers must follow in paying hospital and medical benefits
Sources
Where a figure is indexed, converted or published by a regulator rather than fixed in the instrument, the provenance is recorded separately. Anything marked as a modelled estimate is exactly that — a model, not a statutory number.
- Private health insurance complaintsCommonwealth Ombudsmanretrieved 2026-08-05
What it imposes
Clocks, defences and the ladder.
A rule module builds these while it evaluates, because a limitation period depends on which forum is open to you. What follows is the structure this regime produces — deliberately with no dates and no figures, because those belong to your facts rather than to the law.
What it entitles you to, beyond money
- No further charge where the Medicare benefit was assignedHealth Insurance Act 1973, s. 20A. The assignment is in full payment and satisfaction of the fee for that service.
- A complaint where informed financial consent was not obtainedTake it to the hospital, to the practitioner's college or to the state health complaints commissioner. Insurers also take complaints about gap-scheme information given to members.
Where to take it next
- Ask the practice or hospital for a written itemisation with MBS item numbersAsk which MBS items were billed, what the schedule fee is for each, what benefit was paid, and what the remaining charge is for. Most gap disputes resolve at this point.Claim directtypically 21 days
- Services Australia, or the state health complaints commissionerServices Australia handles Medicare billing questions including improper charging alongside an assignment. Each state and territory has a health complaints commissioner for provider conduct.Regulatortypically 60 days
- Commonwealth Ombudsman — private health insurance functionFor disputes with a private health insurer about benefits, gap cover and information given to members. Free, and it has a strong record of resolving these.Ombudsmantypically 60 daysofficial page
Documents
What this regime can produce.
Every one of these is a document you send yourself, in your own name. Duesday never writes to anybody on your behalf and is never anyone’s agent.
The same claim type elsewhere
EU cross-border healthcare — Directive 2011/24/EU reimbursement, the EHIC and the S2EUSupranational — 27 countriesDirective 2011/24/EU, Arts. 6, 7 and 8Confidence: highFrance — dépassements d'honoraires, secteur 1 and 2, and the OPTAMFRNational — FranceCode de la santé publique, art. R. 4127-53Confidence: mediumGermany — the GOÄ and GOZ private billing schedules and their multiplier limitsDENational — GermanyGebührenordnung für Ärzte (GOÄ), §§ 2, 5 and 12Confidence: mediumIreland — public hospital charges, medical cards and the HSE complaints routeIENational — IrelandHealth Act 1970 (as amended)Confidence: lowItaly — Servizio Sanitario Nazionale, the ticket and the URP routeITNational — ItalyLegge 23 dicembre 1978, n. 833Confidence: lowNetherlands — NZa tariffs, the eigen risico and the SKGZ dispute routeNLNational — NetherlandsWet marktordening gezondheidszorg (Wmg), art. 35Confidence: mediumSpain — Sistema Nacional de Salud coverage and the right to economic informationESNational — SpainLey 41/2002, de autonomía del pacienteConfidence: lowUnited Kingdom — NHS charging, overseas visitor invoices and private healthcareGBNational — United KingdomNational Health Service Act 2006, s. 1(4)Confidence: medium
Other rights in the same countries
Australia — Australia Post compensation and Express Post guaranteeAUNational — AustraliaAustralian Postal Corporation Act 1989 and Australia Post’s Terms and ConditionsConfidence: lowAustralia — Australian Consumer Law consumer guaranteesAUNational — AustraliaAustralian Consumer Law, s 60 (guarantee as to due care and skill)Confidence: highAustralia — Australian Consumer Law unfair contract terms and misleading conductAUNational — AustraliaAustralian Consumer Law, ss.23-28 (unfair contract terms)Confidence: mediumAustralia — ePayments Code and Australian Consumer LawAUNational — AustraliaePayments Code (ASIC), Chapter CConfidence: mediumAustralia — Part IVA representative proceedingsAUNational — AustraliaFederal Court of Australia Act 1976 (Cth), Part IVAConfidence: mediumAustralia — single price rule, ACL s.48AUNational — AustraliaAustralian Consumer Law, s.48 (Competition and Consumer Act 2010, Sch. 2)Confidence: mediumAustralia — State operator passenger charters (NSW TrainLink, V/Line, Queensland Rail) and the Australian Consumer LawAUNational — AustraliaAustralian Consumer Law (Competition and Consumer Act 2010, Schedule 2) and the state operators' customer chartersConfidence: lowAustralia — unclaimed money held by ASIC, and lost superannuation held by the ATOAUNational — AustraliaBanking Act 1959 (Cth), s. 69Confidence: medium
Does this one reach your facts?
The engine runs every regime that could apply at once and reconciles them, rather than making you guess which page to read.
Not a law firm. Not legal advice. You send it yourself. This page describes a law; it is not advice about your situation and no outcome is promised.