Health insurance for pathology tests

What are pathology tests?

Put simply, pathology tests are when you take a sample of body fluids or tissues to detect disease. Generally you'll give a sample at a doctor's office, which will be sent to an off-site pathology lab.

The most common pathology test are:

• Blood tests: Blood tests check for things like infections, anemia, cholesterol levels, organ function (like liver and kidneys) and even signs of certain cancers.
• Urine tests: Urine tests analyse your pee to check for signs of infection (like UTIs), kidney problems, diabetes, and even some types of liver disease.
• Tissue biopsies: Tissue biopsies examine small pieces of tissue from your body to check for things like cancer or other diseases.

Does Medicare cover blood tests and pathology?

Medicare will cover the cost of most pathology tests, including blood and urine tests, as well as tissue biopsies. It does require that your GP and pathology provider bulk bill. If they do, you won't have to pay anything out-of-pocket.

However, not all providers bulk bill, which sucks. In this case, you may have an out-of-pocket cost to pay upfront. Talk to your doctor to find out how much your tests are likely to cost, they should be able to tell give you a break down.

Health insurance for pathology tests

Private health insurance isn't generally much help when it comes to getting routine blood or pathology tests. This is because most pathology will be ordered by your GP, outside of hospital, which private hospital insurance can't cover. Extras technically could cover out-patient costs, but pathology isn't typically included on the list of coverage options.

Now if you're an in-patient of a private hospital, it's a different story. In that case, you might need pathology - a blood test, a biopsy, or more - as part of a larger treatment plan. In this case, your health insurance should step in to cover the costs. This assume your health insurance will cover your treatment overall - this will be a larger conversation you'll need to have with your health fund.

Out-of-pocket costs with health insurance

If your private health insurance is picking up the bill for pathology while you're in hospital, you may still have some out-of-pockets costs. The exact amount will vary a lot depending on the specific test being done, and whether the hospital is part of your health fund's preferred provider network.

The best way to estimate your out-of-pocket costs is to call your health fund's claims department before your go into hospital for treatment. Alternatively, you can look up your specific procedure on Medical Costs Finder, the government site that tracks out-of-pocket costs for private health insurance patients.

Frequently asked questions

• What is a blood test?

  A blood test can be used to assess your overall health and help your doctor diagnose or observe and check the progress of a wide range of conditions. When you undergo a blood test, a small amount of blood is taken from a vein in your arm and then sent off to a pathology service to be tested and analysed.

  Blood tests generally produce accurate results but can sometimes produce 'false positives' or 'false negatives'. Blood tests can be used for an incredibly diverse range of purposes, from checking that your major organs are working correctly to assessing how well your blood is clotting, checking the effectiveness of medications you are taking and testing for diseases such as cancer and diabetes.

• How much do blood tests cost?

  The cost of blood tests varies depending on the type of test. However, under Australian legislation, pathology testing providers cannot issue invoices for pathology services until all testing has been completed. With this in mind, you won't know for sure exactly how much a blood test will cost before your blood is collected, but the pathology service can provide you with an estimate of your out-of-pocket expenses. You can also ask your doctor for information about how the pathology tests will be billed.

  The good news is that Medicare can help cover the cost of blood tests in many situations.

• What happens during a blood test?

  In some cases you may be required to take certain steps to prepare for a blood test, such as fasting for a specific period of time. Blood tests can be conducted in hospital or at a pathology collection centre. Once you've provided your doctor's referral and confirmed your personal details, the collector will usually place a tourniquet around your arm and insert a needle into your vein.

  A small amount of blood will be taken and then collected in one or multiple tubes before being sent to a pathology service for analysis. You'll be asked to apply pressure to the needle site for a short period and you should minimise the use of that arm for the next 24 hours. Some patients can suffer from dizziness or even faint after blood is taken. If you think you're at risk of this, be sure to keep your fluids up and stay seated for a while after your blood has been collected.

  Once your blood sample has been tested and analysed, the results will be sent to your doctor. The time it takes for your results to be ready will vary depending on the type of test you have done.

• Does Medicare cover Pap tests?

  If your doctor has recommended that you get a Pap test or if you've simply been putting it off for a while and decided that it's time to have one, you might be wondering if you'll have any out-of-pocket expenses. The good news is that Medicare provides cover for most of the cost of a Pap test. If your medical practice bulk bills, you probably won't have to pay any out-of-pocket costs.

  However, some medical professionals will charge a fee for performing the Pap test or for the laboratory testing process. As a result, you may have to pay the portion of the total cost that exceeds the Medicare rebate. The MBS lists the fee for a Pap test as $19.45 so a 75% benefit equals $14.60 and an 85% benefit is $16.55.

Written by

Tim Bennett

Insurance expert

A seasoned journalist with over 10 years of experience in news, politics and finance reporting, Tim has previously held roles at the ABC, SBS and Fairfax Media. Tim’s expert insights have been quoted in The Australian, The Daily Telegraph, The Courier Mail and more. He regularly appears on TV and radio, and has been interviewed on 7 News, Sunrise, SBS News, ABC Local, 3AW and 5AA. Tim is passionate about simplifying complex insurance topics for Australian consumers. He holds a Bachelor of Arts (Politics) from Macquarie University and a Tier 1 General Insurance (General Advice) certification, which meets the requirements of ASIC Regulatory Guide 146 (RG146). If you’re interested in a media interview with Tim, please reach out to our PR team at aupr@finder.com. See full bio

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