Splitting Blood Cells

I came across an interesting example of pedantry this week while having the latest in my battery of blood tests. That distinction seems to be based on (a) who filled out the referral form and (b) why the test has been ordered.

First, some background:

Other than those done in hospital, my pathology tests have all been by referral to outside providers. My GP refers me to Douglass Hanly Moir (DHM) who seem to have a monopoly on such services in the Southern Highlands. DHM is part of a publicly-listed for profit company. Presumably, my GP always fills in my Medicare details, though I seem to recall once or twice where the receptionist at DHM has done it from their records. So that’s where I’ve gone for each of my outside-hospital blood tests in recent times.

Royal North Shore Hospital wrote my latest referral out to PaLMS, a NSW Government-owned pathology provider in Northern Sydney and the Central Coast. Since the nearest PaLMS is a 2 hour drive away, I wasn’t going there for a 2 minute blood test. I went along to DHM instead, just as I did last time Royal North Shore wrote a pathology referral. I can’t recall if my Medicare details were filled in last time, but I doubt it.

What happened:

The receptionist at DHM, whom I’ve seen on numerous occasions, said that since Medicare info wasn’t filled in, the test would be billed to me directly. I said that was fine – I have no problem paying fair prices for services – but questioned why this would be the first time they had ever billed me. The response: “Because the referring doctor hasn’t filled out Medicare details.” Ok, whatever.

There was a section on the form for details of people who should receive ‘courtesy copies’ of the results. It was blank. I asked for my GP to receive a copy, but DHM refused, again because it wasn’t on the form. I pointed out that they have had no issue with adding my GP to the form before, but no dice.

So I had the test and went on my way.

I rang DHM today to check the cost. Again, I have no qualms about paying fair charges, but I need to know how much to budget for it. The total, $226.50, to me seems quite excessive, but since I’m not in the medical profession, who am I to argue?

I asked the accounts person why this particular one had been billed rather than charged on Medicare and she said that DHM was a for profit company, not a bulk billing provider and since my referral was to PaLMS, I should have gone there if it was a problem. What about sending a copy to my GP? Again, has to be written in by referrer. (Why? I don’t know. Institutional mind, that’s why.)

I reiterated the question as to why there had been instances in the past where it had been charged to Medicare despite being both on a PaLMS referral and not having Medicare details listed. She offered a few reasons a bulk bill might be made, including:

  • patients who have a lot of tests, or a chronic illness (that’s me)
  • patients requested to be bulk billed by referring doctor (that’s me, but not on this particular form)
  • patients who might be having chemotherapy or similar (that’s me)
  • patients who have low incomes (me, kind of. Put it this way, I probably won’t come up to the tax-free threshold this year)

I pointed out the test was part of ongoing cancer treatment, but basically, too bad, so sad. And that is their prerogative as a private healthcare provider. From now on, I’ll be seeing someone else, as is my prerogative.

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