Medicare ineligible patients

Peter Mac is a specialist, public health cancer centre. In addition to treating public patients, we also treat and care for people who may not meet the criteria for public health access (entry). If you think you do not meet the criteria, it is important to read and understand the following information.

Who can get treatment and care from Peter Mac?

Peter Mac can treat all patients that hold a current Australian Medicare card as a public patient. Medicare is an Australian healthcare system. It provides access (entry) to medical and hospital services and is available to all Australian residents.

In addition to providing care to public patients, Peter Mac also provides care to the following patients:

What does Medicare ineligible mean?

If you are a visitor to Australia and do not hold a Medicare card, you are a Medicare ineligible person.

Medicare ineligible patients are required to pay for all their hospital services. The cost (charges) they are required to pay will depend on the:

  • treatment
  • if there is Australian Health Insurance policy coverage
  • guarantee of payment from an overseas insurance institution.

Care and treatment for Medicare ineligible patients is subject to the following:

Peter Mac will treat and care for Medicare ineligible patients as described in this information sheet. It is important to understand there are criteria (rules) that may affect this.

Access criteria (rules) are:

  • Peter Mac is unable to treat a Medicare ineligible patient if it will delay the treatment of an eligible Australian resident.
  • Peter Mac is required to inform the Department of Health (Victorian State Government) of the intent to treat an individual or individuals who do not have a Medicare card.
  • Peter Mac is required to ensure that overseas patients have the right Medical Treatment Visas in    place before any treatment starts
  • Peter Mac cannot guarantee that an overseas patient will be accepted for treatment and care.  There is a process (described below) to assess every overseas case request.

What are Reciprocal Health Care Agreements?

A Reciprocal Health Care Agreement (RHCA) is where Australia has agreed to provide some health services and subsidised (cheaper) medicines to visitors from some countries.

You may be entitled to these if you are from:

  • New Zealand
  • United Kingdom
  • Ireland
  • Sweden
  • Netherlands
  • Finland
  • Belgium
  • Malta
  • Slovenia
  • Norway
  • Italy.

The RHCA only applies to treatment that is needed for ill health while you are visiting Australia. It does not apply to planned or elective treatment. Eligible patients from RHCA countries must show their current passport.

What is the process to assess overseas patients for treatment and care?

To assess overseas patients, we must consider the patient’s medical history.

This includes:

  1. A full medical history, written in English, must be provided to Peter Mac. It will need to include:
    • a summary letter from patient’s treating doctor, hospital or treatment centre.
    • all previous and/or planned cancer treatments
    • diagnostic imaging (scans and x-rays) with reports
    • pathology (specimen collection eg: bloods/biopsy) reports.
  2. A pre-payment of a non-refundable AUD $500 review fee.
  3. A comprehensive review of the medical history will be undertaken by our Medical Officer who will also involve our relevant cancer experts.
  4. A decision will be made and you will be informed of the outcome.

What happens after considering a patient’s medical history?

If Peter Mac can offer treatment, a written cost estimate (quote) will be provided. It is hard to give an exact cost/quote for charges until the patient is seen and/or treated in person. Please note there are costs associated with all modes of treatment, including clinical trials.

We will advise of any over or under payments, usually after treatment. When this happens, we will either ask for more funds or refund money where it has been overpaid.

Deciding to go ahead with treatment

To go ahead with treatment, the following must happen: 

  1. The cost estimate (quote) must be paid in full before treatment begins.
  2. After payment is made, Peter Mac will contact Australia’s Department of Health and advise of the intent to treat a Medicare ineligible person.
  3. A Medical Treatment Visa must be in place.
    • We can give you information on how to apply for this Visa. Medical Treatment Visa applications are done through the Australian Embassy or Consulate in your country. If you are already in Australia you need to apply through the Department of Immigration and Border Protection.
    • Please note: A Medical Treatment Visa can take days or months to process. Peter Mac has no control over processing times.
  4. If the patient has international or private health insurance, we will need to complete an insurance check to confirm level of cover. This may mean that you will have to pay some or all of your costs upfront.

Before starting treatment

After the required upfront payment is made and a Medical Treatment Visa(s) is approved, we will arrange the first appointment.

Before your first appointment, you will be asked to sign a payment agreement that says you are responsible for all costs relating to your treatment and care.

Please note: Peter Mac does not have onsite accommodation available to overseas (Medicare ineligible) patients. If accommodation is required, we can provide a basic list of what is available locally.

What about asylum seekers and/or refugees?

If you are a refugee or asylum seeker you are entitled to free medical care. You will need to show documents that confirm your status (asylum seeker or refugee) from either:

  • the Department of Immigration and Border Protection

OR

  • a recognised asylum support agency such as-
  • Red Cross or International Health and Medical Services (IHMS).

Paying for treatment

If you are an overseas visitor and Medicare ineligible and accepted for treatment at Peter Mac, you will need to pay for all of your treatment.

How to make payment:

  1. Overseas patients can pay for both the review and treatment quote by internet or international money transfer. For Peter Mac’s bank details, please contact our Medicare Ineligible Coordinator.
  2. Pay in person by cash, EFTPOS, bank cheque or credit card. Visit our cashier on:
  • Level 2 (next to the Pharmacy)
  • Peter MacCallum Cancer Centre, 305 Grattan Street
  • Melbourne VIC 3000
  • Hours: Monday to Friday, 8:30am to 4:00pm     

If paying in person, you will need to bring the following:

  • Passport
  • Overseas residential address
  • Health insurance details
  • Payment upfront
  • Peter Mac quote letter.

3.   Pay over the phone with your credit card. Have your credit card details ready and call:

  • 03 8559 6084
  • Hours: Monday to Friday, 8:30am to 4:00pm.

How to contact Peter Mac

If you have any questions or queries about this information or on accessing our services as an overseas visitor, please call:

What are the costs for overseas visitors?

The following information provides cost/fee information that applies to overseas visitors. These fees/costs are subject to change without notice.

Service or Treatment TypeCost / fees
Outpatients:
First or initial consultfrom $280
Follow-up or subsequent consultsfrom $250
Procedure at first or initial consultfrom $280
Procedure at follow-up or subsequent consultfrom $250
Radiation Therapycontact Medicare Ineligible Coordinator
Allied Health$110 per consult
Inpatient medical service and accomodation
Day onlyfrom $1000
Overnightfrom $1600
Inpatient surgical service and accomodation
Day onlyfrom $1400 per day
Overnightfrom $1800 per day
Other services
ICU - Overnightfrom $4900 per night
HDU - Overnightfrom $3800 per night
Hospital in the Homefrom $1200 per visit
Prosthesisfull cost recovery
Cancer imagingas per Medicare Benefits Schedule plus 50%
Pathologyas per Medicare Benefits schdule plus 40%
Pharmacyfull cost recovery
Interpreter Services$100 per session

The above cost/fees for Peter Mac services and treatments may incur a 40% Medicare Benefit Schedule loading.

For more information regarding the Medicare Benefit Schedule loading please call our Private Patient Liaison Officer on (03) 8559 6086.