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Bulk Billing MRI charges

This may not be news to everyone, but it is certainly news to me. I have had some MRIs in the last few years. I am a pensioner.
Some were bulk billed, others, I was told at the time, were not eligible for bulk billing.
My GP recently referred me to have a spine MRI. I called a couple of places, both said that they do not bulk bill GP referrals, only those from specialists. Eventually, my GP decided that an MRI would be a waste of time.
He eventually referred me to a specialist. I just got to see him, and he send me for a slew of tests including a couple of MRIs. The receptionist asked me where I would like to go, I picked the closest to my home. She faxed them the referral. They phoned me the next morning, to inform me that they are not licenced to bulk bill specialists referrals, only GPs.
To say that I found this confusing, is an understatement.
So, she explained to me (the first person to do so!) that some MRI places are licensed to bulk bill those referred by GPs only, while others specialists only. (I forgot to ask if there are any that can bulk bill both) She asked if I would like her to give me some choices that will bulk bill a specialist’s referral (again, the first person to do so) which she did, so I am now booked in to have my MRI done, bulk billed.
However, this made me wonder how much money I could have saved in the past, had I known that and also wondered how does one find this out, if (apparently) most of the medical profession doesn’t want to divulge this information. Does one need to call all the MRI places to find this out? And how would you even know what to ask? If they ask you (as they did) who is your referral from, and then say, well, in that case, you will have to pay so much out of pocket, you (or at least, I) wouldn’t think to ask, could I go elsewhere to be bulk-billed with this particular referral?

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It’s a really good topic to bring up and one worthy of further investigation (I feel).

It’s not just MRI - CAT scans and simple X-Ray also come in for some confusing treatment.

Cases in point:

  • A Chiropractor I used some time back referred me for pre-treatment X-Ray that was covered by Medicare
  • A doctor I saw last year referred me for a chest X-Ray and I had to pay, whats more the payment was not covered by private health
  • A family member had a CAT scan before dental surgery where the surgery was covered by private health but the X-Rays weren’t - apparently because she 'wasn’t admitted at the time of the CAT scan.
  • A family member had an MRI for possibly knee surgery referred by a surgeon which was not covered by Medicare or private health when going to one location, covered by Medicare at another.

Seems to me the procedure of scanning of any kind is either a legitimately required medical procedure or it isn’t - as a secondary consideration it is either required or elective - if the professional referring the patient is qualified then what does it matter?

Re the Chiropractor reference above - I was surprised it was covered and would have happily paid for that one. I’m still not convinced that Chiropractic has long term benefits - but I know I feel good for 2 weeks :wink:

It would be interesting to hear other experiences also whether anyone can explain the rather perplexing differences in ‘claimability’, both public and private …

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It is not just scans, it is also routine blood tests. My GP always ticks the ‘bulk bill’ box because it is now computerised, but prior to that (long ago) she would sometimes forget. I would not say I educated myself to check and correct as required, but.

Today specialists seem hit and miss whether they tick the bulk billing box. Seems no rhyme, reason, or consistency, just at the whim of the moment, or when they are or or not focusing.

That is courtesy of government where the rules are no private cover unless admitted. Our private system is purposefully handicapped so the medical/hospital insurance does not double dip on Medicare payments nor ‘encourage’ us to get treatment unless we are ill enough to be admitted. It is a bit ridiculous.

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I have also found that some places will honour a bulk billing request if one has a health/concession card, but not to others.

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I had an MRI of my knee this year - NO medicare and NO private health benefit. A very expensive exercise which Im not sure added much to the Dr’s diagnosis.

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That raises another good point - the efficacy of health professionals shotgunning an array of tests to see what they can see. I’m sure there are cases where a casting a wide net yields unexpected but valuable results, but theres been a number of occasions where I’ve had tests including X-Rays/etc and nothing has come of it - of course nothing coming of it is part of the puzzle, but one wonders sometimes whether some diagnostics are really necessary given the cost and potential benefit …

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The difficulty increases for the GP as the probability of age related conditions increases.

For us older and still active folk, the onset of arthritic conditions, tendon inflammation etc and general wear and tear can be one source of soreness, pain and swelling. Of course there may be something more critical that is not apparent as the issue is masked. How should a GP respond when you complain about stiffness walking and a particular joint feeling different? Is there benefit to use imaging type tests to clarify a condition, and create a reference for the future?

Some GP’s may have confidence to make the call unaided. Some GP’s may diagnose on the basis of most likely. Others may simply dismiss the improbable and move on to the next patient.

Are any of us in a better position to know if the tests are required or not required. My preferred GP goes to great lengths to ensure the best outcomes, including explaining what a particular test or scan is intended to achieve. Sometimes the outcome is to have a request form provided with an understanding based on the best assessment the recommended response will be effective within x weeks. Only if the response or progress is not as expected do you then arrange the test/s and book a return visit. Effective, as some Medical Professionals seem to prefer to have you come back after x weeks regardless? Perhaps that could also be a reflection on the patient’s level of need and understanding.

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Well, the MRI and X-rays (and blood tests) ordered was not to find out if I have arthritis, which is a given, but to find out what kind, to determine what treatment is needed
BTW, I was also sent for some blood tests (20!!! - including a urine test) and was informed by the pathologist that one of those can’t be bulk billed, will cost me $50odd (yet to receive the bill)
My GP seems to have no idea (keeps telling me that he has never come across my problem/s) My physio and the rheumatologist beg to differ - seems it is quite common. Maybe time to look for a new GP :thinking:

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If a male and you have a Prostate Specific Antigen (PSA) test done on your bloods more than once in any 12 month period you may have to pay around $50 for the additional test/ing. If you have or have had prostate cancer you can get more frequent tests done for free.

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Well, I just got (most of) my results and I think I know why she said I will be billed, and I now don’t think I will be receiving a bill (the results show older results as comparison, so they would have my records)
One of the results said:
From 1st November 2014, Medicare rebates for vitamin D testing will continue to be available for patients at risk of Vitamin D deficiency such as all those with chronic lack of sun exposure. Further information is available at:
http://www.msac.gov.au/internet/msac/publishing.nsf/Content/0014r-public

BTW, as an aside, I keep wanted to ask my doctor… They have all sorts of signs up in the waiting room about various tests one should have annually, except they all say: Up to the age of 74/75. I wonder why? Are they hoping that those of us older will oblige them by falling off the perch sooner rather than later?
Even the bowel cancer test they mail out to you (I only ever received it once) stops at 74!

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It’s a question of economics, or bang for buck I have been told: The Government want to utilize their bregrudgingly spent health dollars to the maximum effect. They claim to do statistical analyses of health data to determine where the greatest need and effect will be.

That’s not to say older people don’t get sick, it’s just that it is claimed that the statistics show the maximum benefit can be obtained at younger ages.

Of course people in, and working for, the Government NEVER manipulate data or statistics to get the result they want do they?

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Also some complaints if they arise after 75 or so are probably very slow progressing and as such not necessarily worth treating eg some prostate cancers as testosterone levels drop markedly the older you get, breast cancer and it’s link to oestrogen is similar. Some diseases/complications to health however do occur more frequently the older you get and they spend the funds on these in preference eg osteoporosis, senility/dementia, hip replacement, knee replacement and a large number of other typical age related problems.

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This is very useful information. Thank you for sharing.

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Sometimes the imaging adds very little benefit to a diagnostic process. But the clarity of most MRI is startling in comparison to other forms of imaging. Little problems can be detected when all other forms fail. Some tumors/cancers can be detected quite easily with an MRI when they are almost undetectable by other imaging eg CAT scan, standard X-Ray, Ultrasound. In Japan they look to and love MRI for this reason, it is cheap for them compared to our costs, it has no radiation exposure as it uses purely magnetic resonance, and the clarity is just great. If a person is able to have an MRI (there are reasons why some definitely should not have MRIs such as pacemakers) then the results can be beneficial as small defects can be possible to detect that otherwise might remain hidden, I just wish they would reduce the cost of the procedure here.

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I am presuming that x-rays etc may give different information.
Only because my rheumatologist just sent me for a huge amount of tests, including (20 pages!) blood tests, 2 different MRIs AND lots of X-rays
I am sure he wasn’t looking to save me expense :slight_smile:

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Nope as far as I am aware they are just cheaper than MRIs. MRIs give more detailed images. Bone density imaging however does require using x-rays to determine bone density. I am not a medical expert but getting a second opinion from another Dr as to why all the tests is sometimes a good idea.

http://www.sworthogroup.com/general-orthopedic-faq/25-what-is-the-difference-between-x-rays-mri-and-ct-scan

and from https://www.mycdi.com " Magnetic Resonance Imaging (MRI) combines a powerful magnetic field with an advanced computer system and radio waves to produce accurate, detailed pictures of organs, soft tissues, bone and other internal body structures. Differences between normal and abnormal tissue is often clearer on an MRI than CT [my bolding]. There is no radiation exposure with MRI machines".

You could ask why all the tests as they should explain why all of them are needed. You should also be careful about the amount of radiation exposure you get from the X-rays/CT scans and ask if all of those are needed. If they are needed not much you can do about it but be careful about further X-rays during the year. The risk is very small but it is just being mindful of why you are having them done, contrast used increases the dosage but again it is statistically small as a risk.

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He said that he knows I have arthritis, just needs to determine what kind. According to your link, Cat scans show more details than MRI (I never knew this!) yet he didn’t send me for any of those (did have one on my spine last September, and I did show him that)
I am due for a bone density scan soon…
Had quite a few X-rays the last year or so, for various reasons, so I must be visible at night :slight_smile:

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CT/CAT scans produce similar images to MRI but they do not offer as much detail as MRIs normally do. The reference to better images referred to in the SW Ortho link was specifically about the spine but other sites say MRI are better for spinal problems. Perhaps getting a second opinion may be very worthwhile.

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I seem to be specially “lucky” with my referrals. Last year, my GP wanted me to go and get a Calcium Score test. Gave me a referral. Called to make an appointment, and was told that it will be very expensive, as they can’t bulk bull GP referrals.
So, I decided not to go ahead with the test.
Then, just before Christmas I saw a specialist and, remembering the above, asked her if she thinks I should have one. Good idea, she said, and handed me a referral.
So, (given my previous experience) I called around to find a place that WILL bulk bill for this test. Showed up for the test (which, they told me involved no coffee the day before, which was a pain for me) handed over my referral and was informed that the test is not covered at all, there is no Medicare item number for it.
Seems it has to be done in conjunction with a Coronary Angiogram, in which case it is covered and bulk billed. The test would have cost $200 odd.
So, I left again. (and went and bought a cup of coffee, immediately :grinning:) Having thought about it, maybe I should have gone ahead and have it done. I am not due to see taht specialist for 2 years, if i go back to get a different kind of referral, I will have to pay for the visit, which is not that much less than this test would have been. Grrr

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