Private Health Insurance Funds

Approximately 50% of Australians have private health insurance. This is an important area for the osteopathic business model. There is a great deal of variation in the reimbursement rates for osteopathic services between the funds and with different levels of cover in a single fund. Most funds, but not all funds, will reimburse for osteopathic treatment.

Osteopathy Australia is committed to ensuring that osteopaths are treated equitably by the funds when compared with other manual medicine professions. We monitor the cover and advocate for increased reimbursements where osteopaths are treated less favourably than chiropractors or physiotherapists.

Individual private health funds may not operate in all states and territories. Some funds restrict their eligibility for membership to particular professions. With some funds it is necessary to ‘register’ as a provider with the fund and they may provide you with their own provider numbers. The Commonwealth regulates private health funds and there is a great deal of information on the funds available for the public and practitioners: www.privatehealth.gov.au

The most widely recognised private insurance funds by market share are BUPA, Medibank Private, Hospital Contribution Fund (HCF), NIB and HBF.

Visit their websites for more information.

Look for links such as Providers, Information for Health Professionals or Information for Allied Health Professionals.

Health Fund Receipts

Rebates can vary from fund to fund.

In order for patients to claim a rebate from a health fund, the following information must be provided:

• Patient’s name

• Date of service

• Item number

• Allied health professional’s name and provider number

• Address of location of service

• Referring medical practitioner’s name and provider number (or practice address), if applicable

• Date of referral, if applicable

• Amount charged, total amount paid, and any amount outstanding in relation to the service

• Nature of the consultation (e.g. initial or standard treatment). It is not necessary to write ‘osteopathic spinal manipulation’ on the receipt, ‘osteopathic treatment’ will suffice for a claim to be processed. Osteopathy Australia continues to negotiate with the various funds to improve rebates for patients

Ultimately, a patient’s rebate is a matter between the patient and the health fund, and you should take care not to promise rebates. Countless reasons exist why patients with private insurance may not obtain rebates, and these are beyond your knowledge. Examples include a patient not paying their premium, a patient hitting a rebate limit, or a patient using other health services on the same day in the same rebate category (i.e. physiotherapy and osteopathy on the same day).

It is generally against fund rules to claim a rebate where the osteopath treats a family member, and often also with work colleagues (see box below). As a general rule of thumb, either don’t process a claim (i.e. you could still bill privately) or get the patient to check with their fund BEFORE treatment.

Many osteopaths have said that patients are asking them for advice about which health insurer to go with for better rebates. The industry is too complex and osteopaths are not qualified to provide financial advice. Better rebates in osteopathy may mean lower rebates for other services, so it’s best to give general advice only. Tell patients to ring their health fund for a better deal, research and shop around, or visit www.privatehealth.gov.au (a Government website) to help them understand their options.

Treating Family and Business Associates

Many funds do not provide rebates for treating family and business associates, so it is best to either avoid processing these as a rebated service or get the patient to check with their fund first. Health funds are cracking down and auditing this area heavily.

This does not prevent you from doing it, just from claiming a rebate. However, if you decide to treat family, friends or staff, there are also ethical, privacy and other considerations to think about when doing this – for example, what would happen if your treatment caused an injury?

Osteopathy Australia has resources which will help you at www.osteopathy.org.au/article/treating-family--friends-and-staff

Hicaps

The Health Industry Claims and Payments Service (HICAPS) allows patients to present their health fund card at the clinic, saving the patient the hassle of claiming manually at the fund’s retail location. HICAPS user guides

Practitioners must register with HICAPS at each location they practice (and a Medicare provider number is required for each location). We caution members to clarify the arrangements at each clinic where they work. Even if you do not handle transactions, you are accountable for all transactions generated on your behalf.

Osteopathy Australia recommends that when you cease working at a clinic that you ensure that you are removed from the HICAPS system at that location. You can do this by visiting the HICAPS website at www.hicaps.com.au, and navigating to the section on Admin & Support, clicking on Admin & Support home and then on See all forms to amend your account details online.

If you remain active on the system, claims may be made using your code, either inadvertently or otherwise, and this exposes you to investigations by the funds for inappropriate claims. Health funds may suspend or withdraw your right to have patients submit claims for your services through HICAPS if there are irregularities and this would adversely affect your practice while investigations are completed.