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  1. #1
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    Default Phi and Medicare

    If an item can be claimed through both Medicare and phi what is the Medicare amount ( and therefore gap)? My appointment costs $170, with $60 back from phi so I'm $110 out of pocket. Is Medicare then applied to $110 or $170? I'll find out soon just curious now

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    I think you get the medicare rebate back first then PHI is calculated on the remainder.

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    There are set Medicare rebates depending on the item number/s of your claim. Once Medicare is rebated then the gap you've paid can be partially reimbursed by PHI

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    About the practicalities of claiming both- if the practice processes and submits your Medicare rebate for you electronically (which you'll see on the invoice/receipt), you just submit the invoice to your PHI on their form.

    If the practice doesn't electronically process your Medicare claim, you can download a "Two-way claim form" from the Medicare website. Submit it to Medicare with your invoice, and once they've processed their bit they'll pass it on to your PHI for you.


 

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