How does medical claiming work?
Important notice:
On 1 July 2021, health.com.au will join Frank Health Insurance. 24 June is the last day to submit outstanding claims and update your address with health.com.au.
Claiming and the online member area are unavailable from 25 June onwards. You can claim again with Frank from 1 July 2021.
Learn more about upcoming important dates that will affect claiming here.
Now, back to what you came here for: How does medical claiming work?
If you've gotten this far, you're probably looking for help to making a claim for medical services provided in a hospital or day facility.
If your doctor uses the Access Gap Cover scheme, you don’t need to worry about claiming. Your doctor will do this for you. This is what we prefer, as it's much easier, but it's totally up to your doctor. If your doctor doesn’t use the scheme, you'll have to lodge your medical claims with Medicare. This happens via one of the following methods:
- The old fashioned way, by taking your paid invoices in person at a Medicare branch. Let them know you want to submit a Two Way Claim (which means that you’re claiming both through health.com.au and the Medicare system). Be aware this will take them around a month to complete, but you won't have to do any follow up with health.com.au.
- Alternatively, you can ask for a statement of benefit on the spot, and send this to us for claiming. Medicare don’t always forward this and it can take around 8 weeks for them to process, so it's way faster and more reliable if you send it directly to us.
- Or, lodge your medical claims through the Medicare Express Plus App, and then forward us the statement of benefit that's issued to you via your myGov account.
The Medicare Express App is the quickest way for to get what you're owed if it's difficult to get to a Medicare branch, especially if you already have a myGov online account linked to your Medicare account.
If you haven't done this yet, you can do it all from home but you may need a number of pieces of ID on hand, including your Medicare card. Visit myGov to get this started, or login immediately if you already have an account.
When you’ve got your MyGov account linked to Medicare online, you can download the Medicare Express mobile App: and once that’s set up, you can use it to take a photo of your paid invoice, upload it to Medicare that way.
If you need some help setting this up, you can visit the Department of Human Services.
Medicare will assess it within three days and issue you a statement of benefit either via post or via myGov online letters if you have this selected under your Medicare letter preferences. This is what we’ll need to process your claim. Just drop us a line with the statement attached.
Please note: An online claims history available through Medicare online is unsuitable for the purposes of claiming with health.com.au as stated at the end of this document in frustratingly small letters.