There are a number of ways that the costs associated with health care can be reduced and we just wanted to run through the basics of these different options.

Private Health Cover:
Private health funds such as GMHBA, Medibank, BUPA and others all work in similar ways; they have different levels of membership which offer different levels of ‘cover’ for various hospital related health services. These levels differ based on they needs and demands you may have in the future. Health funds also offer ‘extras’ packages which provide cover for various non-hospital related health services. These extras packages are also typically offered in a hierarchy of levels which offer increasing amounts of coverage over a progressively broader range of health services.

Different health funds and their various extras packages will provide different rebate amounts for allied health services such as physiotherapy, myotherapy, osteopathy, chiropractic and exercise physiology. Some packages may only cover a few of these, others may cover all of them. Typically, most health funds will pay for between $300 and $500 of your health service costs and these costs are usually paid out as either a percentage of the consult cost or as a set rebate amount which is the same regardless of the consult rate. The rebates you are entitled to can be claimed at the time of your consult through HICAPS (a type of EFTPOS terminal) or, if you don’t have your card with you, you can claim the rebate online through your health funds website or in person by taking your receipt in with you.

The rebatable amounts offered under your membership reset at the beginning of every calendar year. Amounts that were not used in a year will not carry over to the next years cover. However, services that were used in a year but did not have a rebate claimed can still be submitted for a rebate after the year has finished.

For more information please contact your health fund or view their product disclosure statement.

Chronic Disease Management (CDM) Plans (formerly Enhanced Primary Care Plans):
CDM plans can be prescribed by your GP and can provide you with up to five sessions per calendar year in which Medicare will contribute $52.95 towards your consult costs. Depending on your plan your GP may, for example, choose to prescribe two sessions towards exercise physiology and three sessions towards physiotherapy. You are free to choose with whom, at which clinic and when those sessions are utilised.

The purpose of these sessions is to lessen the financial barriers that may exist in accessing health care services, especially when pain and disability are limiting your capacity to work and earn an income. As these referrals are provided for “chronic” complaints, patients will typically have needed to be suffering with their symptoms or issues for a minimum of three months and will often have to meet other eligibility criteria.

The contribution amount of $52.95 per session can be claimed by your healthcare provider automatically which then leaves the patient to cover the ‘gap’ for the remainder of the consult rate. If a patient also has private health cover the gap amount for a single service cannot be further reduced by your private health fund rebate.

TAC and Worksafe:
The Transport Accident Commission and Worksafe Victoria will provider cover for the cost of care related to transport or work related injuries. To be eligible there are forms and submissions that need to completed by you, your GP and various other entities involved. Once your claim has been lodged then an assessor will assess your claim. If the claim is successful then your case will be passed on to a case manager who will help you access the services that you have been referred to by your GP and health care providers.

Sometimes the claim process can take longer than expected to complete and the wait time can be frustrating. But from the date that your claim is approved then any approved services utilised from that time forward are covered based on a fixed rebate schedule. Your healthcare provider will have a copy of the schedule of provided rebates and the small ‘gap’ between the rebate and the service cost will be an out of pocket cost.

Your case will be reviewed periodically by your GP and by your case manager and your health care providers will be working together to help you return to full work duties and full health as quickly as possible, at which point your case will be closed.

As mentioned previously this is a brief overview of the different ways that health care costs can be reduced by medical and by private means. If you require any further information on these different services then you are recommended to seek out that information through the website of the required service. You are also welcome to contact us with any queries you have about your pain complaint and how these options may apply to you.