Medicare and other 3rd party payment systems

Did you know there are several third party payment systems that cover some or all of the cost of chiropractic and/or massage therapy? Some of these include:

  • Medicare Plans
  • DVA (Veteran’s Affairs)
  • Home Care packages
  • Motor Vehicle Accidents
  • Workers Compensation
  • NDIS plans 

MEDICARE PLANS

Chiropractic health services can be provided to people of all ages with a chronic condition, eg: ongoing or recurring back pain, neck pain, shoulder pain, headaches etc. The patient’s GP creates a Management Plan and Team Care Arrangements to include chiropractic treatment. There can be up to 5 visits per year and each service must be at least 20 minutes duration. Medicare covers approximately 75 – 80 percent of the treatment fee.
Medicare Plans are available for chiropractors and other allied health practitioners but do not cover massage therapy.

DEPT VETERANS AFFAIRS (DVA)

A DVA card – white or gold – covers chiropractic treatment for veterans that is clinically necessary. Massage Therapy is not covered by DVA. The client will need a referral from their GP to begin a chiropractic treatment cycle that will last up to 12 sessions or one year, whichever ends first. Once a treatment cycle has ended, the GP must provide a new referral for another 12 sessions. The client can receive as many treatment cycles as the GP determines are clinically necessary. Treatment is fully paid for by DVA.

HOME CARE PACKAGES

Home Care Packages are subsidised by the Australian Govt. They are available to  seniors who are 65 years and older, or 50 years and older for Aboriginal people. Applicants must undergo an ACAT assessment to determine eligibility. Packages are graded Levels 1 to 4 depending on need, with Level 4 needing the most support. Many Care Organisations now offer self-managed packages that charge a relatively low administration fee (approx 15%). The client can select their own health care practitioners and provide treatment receipts to the Care Package administrator for reimbursement.

Allied health services including chiropractic and remedial massage can be included in Home Care Package funding to treat age-related functional decline.  

MOTOR VEHICLE ACCIDENT

If you are injured in a motor vehice accident your CPT green slip insurer will cover the cost of your treatment if it meets “reasonable and necessary criteria”. This applies to both chiropractic and remedial massage. The patient must submit a CTP claim to the insurer prior to treatment and the chiropractor needs to gain approval from the insurer prior to starting treatment. 

The CTP Green Slip insurer may agree to pay for treatment on a ‘without prejudice’ basis. This means that although the insurer has agreed to pay for treatment, it does not mean they are accepting liability for the accident or will pay for ongoing treatment once they have determined liability.

WORKERS COMPENSATION

For workplace injuries the patient must first notify their supervisor of the injury and submit a workers comp claim to the insurer. Chiropractic and remedial massage treatment is covered by workers comp insurance and must be pre-authorised by the claim manager. The aim of treatment is to facilitate a return to work as soon as possible to help avoid long term incapacity. The patient’s GP must submit a cerificate of capacity / fitness to return to work.

NDIS PLANS

The National Disability Insurance Scheme (NDIS) is for individuals under 65 years old who are living with an ongoing disability. NDIS may cover various types of treatment including chiropractic, remedial massage, lymphatic drainage, sports massage and myotherapy.

Accessing chiropractic and massage therapy through the NDIS involves a discussion of healthcare needs with an NDIS planner or coordinator, who can provide guidance for the inclusion of chiropractic care and massage therapy in the client’s plan. Specific needs may include pain management, improving mobility and other health goals. A medical assessment and referral from a GP or specialist is required to access chiropractic and massage treatment on the NDIS. Practitioners in our clinic are not currently registered with NDIS but may do so if the need arises.

For more information on any of these third party payments, contact us at Blue Vista Health Centre.

Our service area includes Bullaburra, Wentworth Falls, Leura, Katoomba, Blackheath, Lawson, Hazelbrook, Woodford and the greater Blue Mountains.