Chiropractor and Osteopath INFORMATION SHEET Medicare Rebates and Private Health Insurance Cover for Osteopathic Treatment in Australia
f you are considering undertaking a course of osteopathic treatment in Australia, it is important to know to what extent your treatment will be covered under either Medicare, the government-funded universal health scheme, or by your private medical health insurance.
A patient with a chronic condition (e.g. a long-standing musculoskeletal condition), which is being managed by a GP, is eligible for a Medicare rebate for a maximum of five sessions of osteopathic treatment in a calendar year, as provided by an osteopath registered with the Osteopathy Board of Australia. There are, however, certain conditions that are applied in order for a patient to be eligible for the rebate. Firstly, treatment by an osteopath must be recommended by a GP who has provided MBS Chronic Disease Management services to the patient, and as part of the patient’s GP Management Plan (GPMP) and Team Care Arrangements (TCAs). A referring GP is required to use a referral form that is provided by the Department of Health and
Ageing, and this form should be presented to the osteopath at the first treatment session. Once all five sessions have been undertaken, if further treatment is required, a new GP referral is required. Second, if more than five sessions of osteopathic treatment are undertaken, subsequent sessions are not covered by the Medicare rebate. Third, the osteopath is required to provide the referring GP with a written report, usually at the conclusion of the treatment, that will detail the treatment provided, any tests or assessments carried out, and plans for future management of the patient’s condition.
“Patients receiving treatment from an osteopath in Australia are entitled to claim a Medicare rebate for their treatment, provided they meet certain requirements.” A patient who has private medical insurance but who opts not to claim on that insurance for their osteopathic treatment, instead choosing to claim their Medicare rebate, is also eligible to claim for the cost of five ses-
“Most Australian private health insurance schemes offer ancillary or extras cover that includes osteopathic treatment.” sions of treatment in a calendar year, provided the above conditions are met. Further information is provided on the MBS website http://www9.health.gov.au/ mbs/fullDisplay.cfm?type=item&qt=ItemI D&q=10966.
Private health insurance
As osteopaths in Australia are Allied Health Professionals, a patient for whom osteopathic treatment is covered by their private health insurance scheme does not require a referral
from a GP to undertake a course of treatment. Generally speaking, a private health fund will offer either a form of ancillary or extras cover that will: entitle a patient to a set number of osteopathic treatment sessions throughout a calendar year, depending on the level of cover; or, pay a contribution towards the cost of osteopathic treatment sessions, up to an agreed amount. However, it is important for patients to check with their health fund that osteopathy treatment is covered in their particular scheme, and what other expenses they may be liable for. It is also important to know that patients who have chosen not to claim the cost of their osteopathic treatment on their private health insurance, and have instead opted to claim their Medicare rebate, cannot use their private health insurance cover to cover any shortfall between the Medicare rebate and any fees paid for their treatment.
Amber Laris has been treating patients in the heart of the Adelaide CBD for over 30 years. She is a member of both the COCA – Chiropractic and Osteopathic Association of Australia and the CAA – Chiropractic Association of Australia. Level 2 33 Pirie Street, Adelaide SA, 5000 Telephone: (08) 8221 6100
This article was written and distributed by Cadogan and Hall, a freelance writing agency based in Adelaide, South Australia. We specialise in producing online content, websites, blogs, articles and press releases for small- and medium-sized buisnesses.
Published on Dec 10, 2012
Patients receiving treatment from an osteopath in Australia are entitled to claim a Medicare rebate for their treatment, provided they meet...