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In Australia we are lucky to have a health care system called Medicare that helps to pay for our medical costs. Basic access to health providers such as our local doctor or GP and basic hospital and surgery access are funded under this scheme. Other health programs such as immunisation programs for children, the pharmaceutical benefit scheme and the teen dental health plan are also part of the Medicare service. Depending on which doctor we go to and what our requirements are will determine whether Medicare pays all or part of the cost of our visit.

What services Medicare will not cover

Many medical services and complementary health care such as physiotherapy, ambulance services, the cost of glasses and hearing aids, psychology and occupational therapy are not covered under the Medicare scheme in most cases. Private health insurance can help to pay for the cost of these additional services, although individual costs and covers vary greatly.

How Physiotherapist charge?

When you visit the physiotherapist for the first time, you can normally expect to pay a bit more for your initial consultation as it usually takes longer for the assessment, history and diagnosis to be taken. Your next series of appointments may cost a bit less at a standard consultation rate. In most circumstances, you would not expect to be able to claim any of these visits on Medicare. If you have private health insurance, you should be able to claim money back from them, but it will depend on your level of cover.

What services Medicare will cover

There are a couple of programs however that allow you to claim on Medicare for physiotherapy consultations, provided that you meet the criteria. If you have a child with an eligible disability, you may be able to claim physiotherapy treatments as part of The Better Start for Children with Disabilities program or the Helping Children with Autism program. Children who have been diagnosed with cerebral palsy, Down syndrome, fragile-x syndrome, autism or have specified levels of hearing and sight impairment are entitled to Medicare rebates for physiotherapy and other allied health treatments under these programs. The services need to be part of a treatment and management plan that has been set up in collaboration with your referring GP or medical specialist.

Enhanced Primary Care

There is also another program set up for patients who have been identified by their GP as having complex and structured care needs. This initiative is part of the Medicare Enhanced Primary Care program (EPC), which has been designed for the elderly and the chronically ill as part of the allied health and dental care initiative. Other allied health professionals who may participate in this initiative are aboriginal health workers, audiologists, mental health workers, chiropractors, speech pathologists, psychologists, chiropodists, osteopaths and dietitians. The Enhanced Primary Care program provides for more preventative care to older Australians and improves the care coordination between GP’s and other health professionals for patients. To be eligible for this program the patient does need to be identified as having a chronic condition entailing complex and ongoing care that requires a healthcare team. The healthcare team must consist of your GP and at least two other allied health professionals. A chronic condition is one that is of more than six months duration. It can include asthma, diabetes mellitus, cancer, cardiovascular illness, arthritis and musculoskeletal conditions.

Accessing the programs

To access these programs, you will need to speak to your GP who will determine whether you are eligible for these initiatives. If you are eligible, your doctor will develop a care plan and provide you with the appropriate referral forms which will need to be provided to the physio or other health professional before or at the time of treatment. Treatment needs to be face to face and your physio or other allied health professional will discuss your progress and needs with you and your GP. At the end of your treatment your GP will review and discuss the care plan and your future healthcare needs.

If you think that you or your child is eligible for either of these programs, please see your GP for further information and to discuss your healthcare needs.