A rejected claim is usually a surprise – and sometimes the reason why it was rejected is difficult to understand. To help, the table below is searchable so you can quickly find your rejection message, learn what it means, and see what steps you can take.
While browsing the table, keep in mind that the rejection message you received may differ slightly, depending on how and where you submitted your claim.
| How it appears in My Medibank | Meaning and key details | Next steps |
|---|---|---|
| Annual limit has been reached. You can check remaining limits on limits page. | Your claim for this service wasn’t paid because you have reached your annual limit. This means that no benefits will be paid for services of this type rendered this calendar year. | Your annual limits refresh on 1 January. You can check your annual limits anytime on My Medibank online or on the My Medibank app. |
| This service wasn't included under your cover on date of service. | Your claim for this service wasn’t paid because your current cover, or the cover you had at the date of service, doesn’t include the service. | If the date of service is incorrect, you can submit a new claim with the correct date. Otherwise, no benefits are payable for services not included in your cover at the date of service. |
| You may not be registered for service. | Your claim for this wasn't paid because the provider doesn't appear to be registered for this service. | Ask your provider to check their provider number, or if they have another provider number. (A provider may be registered for multiple services and have more than one provider number, and the number has to correspond with the service they provided. For example, a physiotherapist may provide physiotherapy services and remedial massage services, but you won’t be able to claim remedial massage services with their physiotherapy services number, or vice versa.) If the provider number was incorrect, please amend your claim and resubmit. Medibank only pays benefits towards services provided by a registered provider. |
| Your Medibank membership was inactive on the date you received this service. | Your claim for this service wasn’t paid because your Medibank membership wasn’t active on the date you received this service. To be able to claim benefits, you must have been an active member on the date you received this service. | Double-check the date you received this service and if incorrect, amend the claim and resubmit. Otherwise, if you received the service when your membership was closed or suspended, there are no benefits payable. |
| Previously processed a claim for this service. | Your claim for this service wasn’t paid because a benefit appears to have already been paid. | Double-check whether you have already claimed and received benefits for this service; you can do this quickly and easily through My Medibank, either online or on the app. Also, check the date of service you entered when you submitted the claim: if there was an error, amend your claim and resubmit. |
| We do not recognise the item number. Please obtain correct item number from provider and resubmit claim. | Your claim for this service wasn’t paid because we can’t determine the service you are claiming for. The most common reason for this is that your provider hasn’t used the correct item number, or the invoice isn’t clear and legible. | Request an updated invoice from your provider and resubmit your claim. |
| Member is not on this membership. Please correct details and resubmit claim. | Your claim for this service wasn’t paid because your Medibank membership wasn’t active on the date you received this service. To be able to claim benefits, you must have been an active member on the date you received this service. | Double-check the date you received this service and if incorrect, amend the claim and resubmit. Otherwise, if you weren't an active member on this membership on the date of service, there are no benefits payable. |
| Member was not on the membership at the date of service. | Your claim for this service wasn’t paid because your Medibank membership wasn’t active on the date you received this service. To be able to claim benefits, you must have been an active member on the date you received this service. | Double-check the date you received this service and if incorrect, amend the claim and resubmit. Otherwise, if you weren't an active member under this membership on the date of service, there are no benefits payable. |
| We're unable to pay benefits for this claim. For more information or if you think there's been an error, please get in touch. | Your claim for this service wasn’t paid. | Please contact us for more information. |
| Payments for your Medibank membership weren't up to date on the date you received this service. | Your claim for this service wasn’t paid because payments for your Medibank membership weren't up to date when you received this service. To be able to claim benefits, your policy premium must be paid up to date. | Once you have paid your policy premium up to date, you can resubmit your claim. For more information on what to do when your policy is in arrears, please see our What to do when you can't pay your premium guide |
| Charge amount is missing or incorrect. Please obtain an amended account to re-submit the claim. | Your claim for this service wasn’t paid because the charge amount is missing or incorrect. To be able to claim benefits, each service you received must have a corresponding charge amount. We can’t process your claim if your invoice doesn’t include a charge amount, or only has one total charge for multiple services. | Contact your provider to reissue you with an invoice that has a charge breakdown for each service you received. You can then resubmit your claim. |
| Provider was not registered at the date of service. Please ask provider to amend their details and resubmit claim. | Your claim for this service wasn’t paid because it appears that your service provider wasn’t registered at the date of service. To be able to claim benefits, your service provider must be registered with Medibank. | Contact your service provider to ask if they can amend their provider details; you can then resubmit your claim. |
| Date of service is over 1 day ago. We only allow up to 1 day to lodge a claim for this service. | Your benefit for this service was not paid because the HICAPS claim has a Date of Service of a day or more before it was lodged. | If you think there's been an error, please send us a copy of the invoice so that we can re-assess your claim. |
| Only two of this type of service every calendar year are payable. | Your claim for this service wasn’t paid because you can claim only two of this type of service every calendar year. This is because some services have restrictions on the number of services you can receive; we base these restrictions on professional advice. | If appropriate, discuss with your service provider whether you may be able to split the services you receive into different calendar years. Otherwise, there are no further benefits payable if you have received more than two of these services in a single calendar year. |
| Only one of this type of service every calendar year is payable. | Your claim for this service wasn’t paid because you can claim only one of this type of service every calendar year. This is because some services have restrictions on the number of services you can receive; we base these restrictions on professional advice. | If appropriate, discuss with your service provider whether you may be able to split the services you receive into different calendar years. Otherwise, there are no further benefits payable if you have received more than one of these services in a single calendar year. |
| Provider was not recognised by Medibank at the date of service. Please contact us for more information. | Your claim for this service wasn’t paid because it appears that your service provider wasn’t registered at the date of service. To be able to claim benefits, your service provider must be registered with Medibank. | Contact your service provider to ask if they can amend their provider details; you can then resubmit your claim. |
| Service took place during waiting period. | Your claim for this service wasn’t paid because it appears that you received the service during a waiting period. Any services you receive during your waiting period aren’t eligible for benefits, even if you submit the claim after the waiting period is over. | If it took place after you have served your waiting period, you can amend your claim and resubmit. Remember you can check your waiting periods anytime on My Medibank online or on the My Medibank app. |
| Claim rejected because the cost of this pharmaceutical item is lower than the co-payment. | Your claim for this service wasn’t paid because the cost of this pharmaceutical item or allergen extract is lower than the PBS co-payment amount. Benefits are payable only when a) it’s prescribed by a person who is legally allowed to do so (i.e. a medical provider, dentist, optometrist, midwife, nurse practitioner or pharmacist) and b) the cost is above the current PBS co-payment amount. | Check the cost of the item; if it’s higher than the PBS co-payment amount, you can amend your claim and resubmit. Otherwise, there is no benefit payable if the cost is under the PBS amount. |
| Claim has been paid at previous level of cover because you are still on waiting period for upgraded level of cover. | Your claim for this service wasn’t paid because it looks like you are in waiting period for a higher level of cover and the benefit has been paid based on your previous level of cover. After you change your cover, the benefits you’re paid are determined by the date you received your service. | You can check your cover summary on My Medibank online or on the My Medibank app to confirm when your waiting periods expire for the higher benefits and limits. Until then, any claims you submit will be processed under your previous level of cover. |