Key takeaways
- Medicare will cover most of the pathology tests your likely to need.
- If there are out of-pocket-costs, health insurance won't cover them outside of hospital.
- For pathology tests in a private hospital your health insurance policy can cover you.
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.
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