Private Health Fund Rebates



Physiotherapy is covered under the ancillary cover of your Private Health Insurance.  On the spot processing available through HICAPS for most Health funds so you only pay the gap.

Eftpos
Credit Card
HICAPS
Cheque
Cash 

Payments are required following each consultation

Veterans Affairs
Veterans Affairs require Gold Card or White Card for Specific Conditions plus referral.

Workcover Claims
Workcover claims are billed directly to Workcover.

Compulsory Third Party Claims
Compulsory Third Party claims are billed directly to insurer once claim accepted.

Medicare
Patients with complex and chronic conditions may be covered by Medicare for up to 5 physiotherapy session per year.
Patients must be referred by their GP and require an Enhanced Primary Care Plan from the GP to be brought to the initial consultation. 
At totalphysio, Medicare contributes $48.95 towards the cost of the treamtent when referred with an EPC . 

Questions and Answers for
MEDICARE and PHYSIOTHERAPY

Q.  Can I get a Medicare rebate for physiotherapy?

A.  From 1 July 2004, you may qualify to receive a Medicare rebate for physiotherapy, including musculoskeletal physiotherapy.

It is now possible for people with chronic conditions and complex care needs to receive a Medicare rebate for up to five physiotherapy services per year.

Q. Who is eligible?

A. To be eligible for a Medicare rebate, you need to be placed on a Community Care Plan by your GP, and referred to your physiotherapist.

 
Q.  How do I get placed on a Community Care Plan? A. If you think you have a chronic condition and complex care needs, then you can discuss this with your GP, and ask them to prepare a Community Care Plan for you.  If your GP agrees that you would benefit from a Community Care Plan, then you can be referred for up to five physiotherapy treatments per year.  The Medicare schedule fee under this scheme is $51.75 and a rebate of $47.85 for each physiotherapy treatment applies.


Q. What is meant by chronic conditions and complex care needs?

A. Chronic conditions are defined as conditions which have been, or are likely to be, present for six months or more.Complex care needs means that, in your doctor’s opinion, you would benefit from care provided by a range of health professionals, who provide different services to doctors.  In the past GPs have decided that patients have complex care needs if:

•  they have multiple health problems
•  they are increasingly frail or dependent
•  their health is unstable or deteriorating

If any of these examples describes your condition, then you may be eligible for the Medicare rebate for physiotherapy, under a Community Care Plan prepared by your GP.

Q. Once I’m on a Community Care Plan, how do I get my Medicare rebate?

A.  In order to receive your Medicare rebate for physiotherapy, your GP must provide you with a referral to a physiotherapist on the appropriate referral form.  You must take the referral form with you when you visit your physiotherapist, or you will not be eligible for a rebate.

 

Q.  Do all physiotherapists use the same treatment methods?

A.  Many physiotherapists specialise in one or more areas of physiotherapy, and can provide expert treatment in conditions relating to that area.  Ask for a referral to a physiotherapist who specialises in treating your particular health conditions. 

 (reproduced from APA brochure August 2004)