A common question we get asked in clinic is if a patient can claim through Medicare for their Physiotherapy and Exercise Physiology services.
You can - but you have to meet specific criteria. Medicare is not like private health insurance. If you have extra's cover on your private health insurance, then you can claim through your health insurance. The amount that you can claim is dependent on your level of cover and who you are insured with. This is claimed on the day with our HiCaps machine and there may be a gap payable.
Medicare is different. It is not connected to a health insurer and does not work like it does for GP's and specialists. To be eligible to claim a rebate from Medicare for any allied health service (including physiotherapy and Exercise Physiology), you will need a specific referral from your GP.
How does this work?
GP's will discuss your eligibility with you to determine if you can receive Medicare subsidised allied health services. This often requires an extended consultation with your GP and practice nurse to complete paperwork that must be submitted to Medicare. You will also receive a referral for physiotherapy and/or Exercise Physiology. This program is called the Chronic Disease Management program (CDM for short) - or more well known by it's previous name - EPC (Enhanced Primary Care Plan).
What is the eligibility?
The CDM or EPC plan requires eligible patients to be under the care of 3 health practitioners (often the GP, Physiotherapist and Exercise Physiology or another practitioner - which could be a specialist, surgeon or other allied health practitioner). It also requires patients to have a complex and chronic condition - meaning that the condition must have been present for, or likely to be present for, more than 6 months. The aim of this program is to provide assisted care for patients who require a structured approach and require ongoing care from a multi-disciplinary team. It must be noted that the GP is one who makes the final judgement call on eligibility for this plan.
How many sessions do I get?
If you meet the eligibility, you will have 5 allied health sessions available per calendar year. This unfortunately doesn't mean 5 of each allied health discipline, but 5 in total. This is a great start for many people, however chronic and complex conditions require more than 5 sessions to treat properly - which is important in planning what the best course of action is with your physiotherapist or Exercise Physiologist.
Is it free?
Getting the plan is subsidised by Medicare. The sessions under Medicare are meant to subsidise the standard cost of care for that allied health practitioner. This means that most practitioners charge a gap payment as Medicare only covers a small portion of the total cost of the consultation. At our clinic, we DO NOT charge a gap payment if the session is before 5pm. We recognise that many patients are unable to afford quality care and provide this option.
If you have any further questions about this program - or if you have an EPC/CDM plan, please give us a call on 95801985 or make a booking by clicking on this link.