I will pay for or am liable to pay the expenses for doctor’s services and these services are not excluded under the Health Insurance Act 1973 (i.e. are not for the purpose of life insurance, superannuation or provident account schemes, admission to a friendly society, health screening, mass immunisation or connected with employment) and/or Dental Benefits Act 2008.
To the best of my knowledge and belief all the information provided to Northern Beaches Neurology for the lodgement of Medicare claim is true and accurate. I authorise the medical practice to electronically transmit my claim for Medicare benefits to the Australian Government Department of Human Services on my behalf.
I also authorise the Australian Government Department of Human Services to contact the referring provider or the provider of the services if clarification of details on the account and/or receipt is required for assessment or auditing purposes. For my Medicare claim, I consent to this practice sending to, and receiving from the Australian Government Department of Human Services, the following information for verification:
- The patient’s enrolment information including the patient’s Medicare card and issue number;
- The patient’s first name and individual reference number;
- The claimant’s postcode information provided it matches my records; and
- The benefit amount for each service in this claim.
Privacy Notice: Your personal information is protected by law, including the Privacy Act 1988, and is collected by the Australian Government Department of Human Services for the assessment and administration of payments and services. This information is required to process your application or claim.
The Medicare Benefit will be paid:
If your bank account details are stored with Medicare your payment will be made by EFT, if not, your Medicare benefit will not be paid. Once you have provided Medicare with your bank account details, your payment will be released.
If required, correspondence regarding the claim will be directed to the:
Address held by Medicare
This includes, if applicable, any Pay Doctor via Claimant (PDVC) cheques for the service provider. It is the responsibility of the claimant to forward the PDVC cheque to the service provider or to bring it to Medicare office for further enquiry.