Your billing explained
An overview of billing for radiation therapy
- Radiation treatment is typically an out of hospital (‘outpatient’) service, with a cost involved for your care
- Private health funds do not cover outpatient services
- Medicare covers approximately 80% of treatment costs (depending on your position within your Medicare Safety Nets)
- Following your initial doctor consult, you will have a dedicated fee conversation with a team member who will be able to provide you with an estimate for the cost of your care and will go through billing, invoicing and Medicare rebates in detail
- Your exact out-of-pocket costs depend on a number of factors including your personal treatment plan, complexity and your position within your Medicare Safety Nets
Invoicing and Medicare
Following your fee conversation, you will be provided with an estimate for your total cost of care. Payments are broken into a number of separate invoices throughout the course of your treatment. Paid invoices are usually reimbursed within 48 hours of a claim being submitted to Medicare.
| Step 1: Invoice | You will be invoiced for the services received, as you receive them. This will include invoices for:
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| Step 2: Payment | You will be invoiced for the services received, as you receive them. Reimbursement claims cannot be made until an invoice is paid in full. |
| Step 3: Claiming: | After each invoice is paid in full, GenesisCare will submit a claim to Medicare so you can be reimbursed your eligible Medicare benefits. |
| Step 4: Reimbursement | Medicare reimburses you directly into your bank account, normally within 48 hours of a claim being submitted. Exceptions may apply. |
* Simulation and dosimetry are the services required to be performed before any course of radiotherapy can commence. During simulation, your treatment area is scanned and measured. Dosimetry (sometimes referred to as planning) is the behind-the-scenes work your doctor and radiation therapist do after simulation to design your personal course of treatment.
Extended Medicare Safety Net
What is the Extended Medicare Safety Net?
The Extended Medicare Safety Net (EMSN) is an Australian Government initiative designed to provide additional financial relief for individuals and families who have high out-of-pocket medical costs for out-of-hospital services. It reduces Out-Of-Pocket (OOP) expenses once a patient reaches a certain threshold of medical costs within a calendar year.
If you’re enrolled in Medicare you’re eligible for the EMSN. Each time you pay an out of pocket cost, it’s calculated towards the EMSN threshold.
How does this impact my OOP costs?
Once you hit the EMSN threshold you will recieve an extra rebate on the gap between the standard Medicare benefit and certain treatment costs. This will reduce your final OOP expenses.
How to find your position on the EMSN?
To get a more accurate estimate of your OOP costs, it’s helpful if you arrive to your fee conversation knowing your position on the EMSN. You can get this from the Medicare app on your mobile phone, from your myGov account or by phoning Medicare directly. Unfortunately, it’s difficult for healthcare providers to get this information on behalf of patients.
Step 1: Log into your Medicare app, and go to Safety Net
Step 2: Your position should be easily visible
Step 1: Log in to myGov to access Medicare through linked services
Step 2: Your position should be easily visible
Step 1: Dial 132 011 and follow the prompts
When does the EMSN Reset?
Medicare Safety Nets resets every calendar year, 1 January – 31 December. This means your Medicare rebate will be reduced from 1 January until you reach the Extended Medicare Safety Net threshold again.
Where can I get more information?
For more information on the EMSN visit:
- Extended Medicare Safety Net on the Services Australia website
- Medicare Safety Nets on the Department of Health and Aged Care website
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