In the midst of the stress and pain of an injury, the last thing you want to be doing is figuring out how our health system works and how you might be able to access funding, public or private, to pay for your Physiotherapy or associated costs.
This blog is to give you an overview of how you may be able to access funding in the context of accessing Physiotherapy in a private practice.
Please note all advice is general and subject to change, and we would advise you to look into each funding body in more detail if the time comes that you need it!
Part 1. Medicare funded or subsidised healthcare.
Medicare subsidised Physiotherapy (CDM)
Medicare subsidised scans: X-Rays, Ultrasounds, MRIS, CT Scans.
Emergency Department (ED) vs St John’s Urgent Care
Department of Veterans Affairs (DVA)
Glossary:
”Rebate” - A partial payment or refund, you either pay the full amount up front to the practice and are then refunded a portion after an appointment, or the fund pays a portion directly to the practice and you pay the “gap”.
“Bulk Bill" - You don’t pay anything and the insurer / fund pays the practice instead.
Medicare funded Physiotherapy sessions
What is Medicare?
Medicare is Australia’s universal health insurance scheme. Australians help to pay for Medicare from income tax. How much you pay depends on your income.
What does Medicare fund when it comes to private Physiotherapy practices?
If you have a chronic condition, or complex care needs that are overseen by a GP, you may be eligible to receive a Chronic Disease Management (CDM, previously “EPC”) referral from your GP.
With this you can access 5 Medicare subsidised Physiotherapy sessions per calendar year.
The amount Medicare subsidises at time of writing is $58.30
While some Physiotherapy clinics may offer “bulk billing”, most clinics will require you to pay a gap as this amount does not cover the costs of a standard appointment.
An important point to note is that these sessions are counted in each calendar year, so it’s best to try use your sessions within the year as the number is reset at the start of each year.
For example if you received your CDM referral for 5 sessions in November 2023, but only get to 3 appointments, the leftover 2 sessions are counted towards your 5 sessions in 2024.
For more information visit this link
2. Medicare funded or subsidised scans
Medicare funds a portion of certain scans like X-Rays, Ultrasounds (US) and MRIs that you may need to help investigate certain diagnoses.
X-Rays and US are generally cheaper and can be good as an initial investigation to investigate boney tisue and soft tissue respectively.
MRIs can provide a lot more information on conditions and can visualise larger areas in more detail including soft tissues, joints, bones, muscles, or cartilage and may show things that may be missed on X-Ray and US.
They are however quite expensive and can cost between $250 - $375 for one area if paid privately in full. We suggest asking each individual company what their fees are as they do vary. Some of the common ones are SKG, PRC, I-Med and Envision.
For Medicare cover it is often required that these scans are referred by specific healthcare professionals for them to be covered, either partially or fully.
Key Points:
Physiotherapists can refer for Xrays, Ultrasounds and MRIs - however some Xrays, Ultrasounds and all MRIs are not rebatable by medicare if referred through Physio.
Most X-Rays and Ultrasounds referred by GPs are bulk billable. Some MRI’s are bulk billable but only for certain conditions.
Physiotherapists cannot refer for CT Scans
Medicare will generally give higher rebates for MRIs and many other scans if referred by specialists, Sports Medicine Physicians (Sports Doctors) and orthopaedic surgeons. However, their consultation fee in itself may be quite costly, and often you’ll need a referral from a GP to see them, particularly Orthopaedic Surgeons.
Often deciding what to do will depend on whether cost or the quickest most direct route is more of the priority. Sort of like booking flights to Europe!
3. Emergency Department (ED) vs St John’s Urgent Care.
St John’s urgent care is a new initiative that has been designed to ease the overwhelm of our Emergency Department. At St John’s Urgent Care you can often be seen much quicker for injuries and conditions of an urgent nature non-life threatening, like bad sprains, breaks or back pain.
Generally if you head to the ED with a non-life threatening condition, especially for musculoskeletal issues, the triage system which decides the priority of your medical condition will put you towards the bottom of the list which means you could have excessively long wait times.
In these instances you may be better off heading to a St John’s Urgent Care where you are likely to receive treatment quicker. You may also be able to receive better advice in what to do in the aftercare, as often this is impossible to do in the Emergency Department when it is very busy.
The conditions that you should head to the ED are generally things like the following:
Chest pain or tightness
Breathing difficulties
Uncontrollable bleeding
Severe burns
Poisoning
Unconsciousness or seizures
Numbness or paralysis
A life-threatening injury
On-going fever in infants
Unresponsive
It is also important to note that regardless of whether you are cleared in the ED or at St John’s Urgent Care for a musculoskeletal injury you should still get it followed up by your GP or with a Physiotherapist for advice on what to do next if there is still treatment or rehab required (like an ankle sprain).
As you know often a full Physiotherapy assessment and treatment plan can take much longer than the 10-15mins you may only get in our emergency departments. While treatment in the ED is often completely covered by Medicare, and subsidised at St John’s Urgent Care often this is reflected by the limited time and individualised care and aftercare you may receive.
4. Department of Veterans Affairs (DVA)
What is DVA?
The Department of Veterans Affairs is a department of the Australian Government and provides certain support, health care and rehabilitation services and information for veterans, their dependants and a range of other associated people. While it is not directly funded by Medicare a lot of the systems are similar which is why we have included it here.
How Do I Access Physiotherapy Services Under DVA?
You may be able to receive physiotherapy services if you have an assessed clinical need and:
a Veteran Gold Card; or
a Veteran White Card and your treatment is for an accepted service-related condition. e.g. Osteitis Pubis
You’ll need a referral from your GP or another medical practitioner. The referral allows you access to 12 sessions and this lasts for 1 year only (then you’ll need another referral).
All sessions under DVA are “bullk billed” meaning you won’t pay anything to your Physiotherapist.
Stay tuned for Part 2 of Navigating our Health System where we will cover:
Worker’s Compensation (WC insurance)
Motor vehicle accident insurance (ICWA)
Sporting body insurance
NDIS (National Disability Insurance Scheme)
Private Health Insurance (PHI)
Let us know in the comments if you have any requests or questions.