Health Funds

How to Claim a Rebate

Health Funds

Claiming with private health insurance is easy.

Step 1: Present Card

Bring your private health insurance card with you to your consultation and present it to the front desk prior to payment.

Step 2: Rebate given based upon service delivered

You will be charged a service “Item Number” code based upon the service conducted. See Table 1 Column 2. The rebate given from each health fund can vary for each item number so please contact your private health insurance to determine how much of the treatment cost they will cover, if you are unsure.

Be aware that Physiotherapy and Exercise Physiology may or may not fall in the same category in your health fund; so check if you are covered for both. If the services are in different categories this means that the services claimed by physiotherapy consultations will not affect services claimable by exercise physiology.

Health funds can claim for the following service items:

Physiotherapy Service

Service Type Item number Cost
Initial Consultation 500 $100
Standard Consultation 505 $85
Long Consultation 510 $170
Group Therapy 560 $50
Gym Memberships
Membership Fees Contact your health fund to find out more

Step 3: The gap payment

The full service amount will be charged, the health fund will give you a rebated based upon their fee schedule and you will then be charged a gap payment.The remaining gap amount can be paid for by EFTPOS, credit card (2% surcharge), cash or cheque.

Backdated payments

Please note services can only be back dated approximately 2 days, if you forget your card you will be required to pay the full amount, for which you can claim online with your particular health fund. Please inform the staff at the front desk as a receipt will need to be issued to you.

Claiming on the same day for two services in the same payment group

It is not possible to claim two physiotherapy services (e.g. Standard Consultation and Group Therapy) for the same treatment date. Please keep this in mind when booking appointments.

Audits:

Health funds can conduct random audits of clinical notes and claim history. Clinical notes must be taken by the physiotherapist or exercise physiologist after every session. It is imperative you are booked into group studio classes so that all payments and notes are accurate. We will aim to seek consent from the individual where clinical notes are requested by the health fund prior to submitting the audit.

Medicare

Claiming Physiotherapy and Exercise Physiology on Medicare.

You are eligible to claim 5 sessions per calendar year for chronic health conditions. As part of a team plan you must have seen at least two practitioners (excluding your doctor) to be eligible. To initiate the Enhance Primary Care (EPC) plan you must see your local doctor.

Exercise Physiology Additional Sessions

Diabetes sufferers are able to apply for an additional single session for a diabetes session and to claim up to 8 group therapy classes.

Consultant name on form

Ask your doctor not to specifically request a physiotherapist or exercise physiologist but rather address the form to Physio GymTM physiotherapy. This is because the forms are very specific, if you have a certain physiotherapist or practitioners name on the form then you can only see them. This may be a problem if they are not available.

Treating Consultant

When you book your EPC sessions in at Physio GymTM physiotherapy you will be allocated a therapist to treat you. You can only see this therapist for all sessions, so book your sessions in advance.

Payment Rebate

If you have and Enhanced Primary Care (EPC) plan from your Doctor you must bring the care plan with you to your consultation as this is required to complete the claiming process.
Following payment in full of the total consultation cost, either the claim will be submitted online and the Medicare rebate will be sent to you via cheque or deposited into your account (based upon details you have provided to Medicare); or we can swipe your Medicare card on the spot and process the money back into your cheque or savings account. Please note, a Medicare rebate cannot be placed into a credit account. You will have to check with Medicare as to the amount of rebate available to you as everyone differs.
You normally get a rebate of $54.90. A gap amount is charge on top of this for the agreed Physiotherapist or Exercise Physiologist cost.

Department of Veterans Affairs

This service is available for veterans, current serving members, family, carers and former serving members. If you are entitled to claim under the DVA system, please bring your DVA card with you and a referral from your General Practitioner. Other referral services include local medical officer, medical specialist, treating doctor in hospital, hospital discharge planner or another physiotherapist who has received a referral. There will be a small amount of paper work to fill out after the consultation to complete the claim process. On your first session the physiotherapist will assess your need for therapy and prepares a care plan. At the completion of each treatment session, there will be a voucher for you to sign; you will receive a copy of this voucher for your own records. You do not need to pay for this consultation; Physio Gym will do the required paperwork to be reimbursed for the session.