Suffering from Niggling Injuries and General Wear and Tear? Don’t Let It Stop You from Living Your Best Life. Health Insurance for Physiotherapy Treatments Can Help Save You Money and Get You Back to 100% ASAP.
Are you struggling with ongoing muscle or joint pain? Maybe you've been dealing with limited movement due to an injury. Or perhaps you often feel stiff and sore - which tends to happen as we age!
Whatever the case may be, physiotherapists are here to help. They specialise in treating various pain complaints using techniques like manipulation, joint mobilisation, massage, and therapeutic exercise to reduce stiffness and pain, allowing you to regain your mobility and overall well-being.
If you're looking to improve your health and get back to doing the things you love without feeling the toll on your body, scheduling a consultation with a physiotherapist could be just what you need. Unfortunately, if you rely solely on Medicare, they only cover the cost of physiotherapy if you're an inpatient in a public hospital.
The good news is this limitation can be remedied with private health insurance to help cover a portion of your physio expenses. Depending on the extras cover you choose, you could end up paying very little or even nothing at all for your physio treatment plan. That sounds pretty good, doesn't it?
In this guide, we'll provide you with all the essential details you need to know to find the best health insurance policy for all your physio needs.
Who can benefit from physio health insurance?
Physio insurance isn’t just for AFL athletes or those who have a chronic movement disorder. Almost everyone at some point can benefit from physiotherapy health cover. Whether you’re young and fit or in the later stage of your life, there are plenty of reasons why you might benefit from physiotherapy.
However, paying for ongoing physio treatments to improve mobility and activity out of your own pocket doesn’t come cheap.
That’s where health insurance for physiotherapy comes in. When you take out an extras policy, even when combined with hospital cover, you can significantly save on [health insurance extras|/extras-cover/health insurance extras like physio. That means more money to spend enjoying your health and less money keeping your body in tip-top condition.
If you struggle with any of these health issues, you’re likely to benefit from physio health cover:
- If you’re recovering from an accident or injury
- If you suffer from a movement disorder
- If you have a chronic illness
- If you have a neurological disorder like a stroke or multiple sclerosis
- If you play a sport with a high risk of injury
- If you work in a labour-intensive job
- If you’ve suffered from pregnancy complications
- If you suffer from postural neck and back pain
There’s only one way of finding the best private health insurance for physio services and that’s to compare policies. Our online comparison insurance quotes tool helps you find the right hospital cover and extras cover or your needs from a range of health funds.
Common conditions that require ongoing physiotherapy
Some health insurance funds will cover all types of physiotherapy treatments - musculoskeletal, cardiothoracic, and neurological conditions - under their extras policy but others won’t. That’s why understanding what’s included and comparing the policies is important if you want to get the most from your cover.
The common conditions requiring ongoing physiotherapy treatments are:
COMMON PHYSIOTHERAPY EXPENSES COVERED
A percentage or annual dollar amount of your physiotherapy expenses are covered under an extras policy. The level of your extras cover will determine what physio-related treatments and services you can claim. For example, some basic extras policies will have a very limited number of services available or exclude things like physio, osteo, and remedial massage altogether. On the other hand, top or comprehensive extras cover will have a greater variety of options you can choose from.
Some of the most common physiotherapy services covered on extras policies include:
How Much Can You Claim Back with Health Insurance for Physiotherapy Treatments?
As you probably know, extras cover works a little differently from hospital cover or ambulance cover. The amount you can claim back for physio-related treatments will depend on your policy and your health fund provider.
The benefit amount is calculated by the insurer using one of two methods:
1. Percentage Benefits
As the name suggests, percentage benefits are calculated as a percentage. For example, you might receive 50% back from your physio treatment. So if the treatment costs $100, you will get $50 back. The percentage benefit structure allows you to know what you’ll be reimbursed from your health fund regardless of the cost of the treatment.
However, there is a downside to percentage benefits which is that it applies to all extra services under your policy. That means you’re unable to prioritise the types of treatments and services that are most important to you. If you’re able to, paying a higher premium may result in a higher percentage rebate.
2. Set Benefits
With a set benefit, your rebates will be in the form of a fixed dollar amount for eligible services claimed. For example, you may receive $70 back from your initial physio consultation, leaving you to pay the remaining $50 of a $120 bill. The advantage of set benefits is that you can customise your cover to select a policy that offers higher benefits for services you need most.
The downside of set benefits is that calculating your out-of-pocket expenses is more challenging. Unless you know how much your physio session will cost you, you won’t be able to work out how much you need to pay.
Do annual limits apply to physiotherapy?
Yes, annual limits will apply to the maximum rebate that you’re able to claim per person insured in each calendar year.
The annual limit on physiotherapy will depend on your chosen health fund and the level of extras cover. Typically, a higher level of cover will give you higher annual limits.
Limits on your extras cover are generally broken down into two categories:
1. Combined Limits
If your extras policy specifies combined limits, this means several services fall under the one limit. For example, your physiotherapy cover may be grouped with chiropractic treatments and remedial massage under the banner of physical therapy. So if you max out your limit on physio treatments you won’t have any benefits remaining for the other combined services.
Extras cover with sub-limits means specific treatments under the one category will have individual benefits. For example, if your extras cover offers physical therapy benefits, you may receive a limit of $200 for physio and $80 for remedial massage.
Lifetime limits is another limited category however it’s rarely used and typically applies to orthodontic treatments. With a lifetime limit, your benefit limits aren’t renewed annually.
Other limits to considerExtras cover can have other limits you should consider when comparing policies.
These include the following:
1. Time limitsIf time limits are applied to your extras cover, you must lodge your claim within two years of the date you received treatment.
2. Service limits
There may also be a service limit applied to your extras cover. This means there will be a limit on the number of times you can claim for the same service. For example, there may be a limit on the number of times in a calendar year you can claim for a consultation with a physiotherapist.
3. Benefit limits
It’s common for your new health insurer to apply a limit on the benefits you can claim per day. For example, if you receive two services within the one consultation, such as general dental, you may only be able to claim on one service.
How long will I have to wait to claim for physio health services?
The waiting periods for extras cover are set by each individual fund, not by the government. As a general rule of thumb, you can expect to wait 2 months before you can claim your physiotherapy treatments.
Provided you maintain the same level of cover, once you’ve served the waiting period, you can switch policies without worrying about having to re-serve the waiting period.
It’s not uncommon for health funds to run promotions offering extras cover with no waiting periods to attract new members, which may be combined with basic hospital cover. These are sometimes specifically targeted at certain customers, like single parents, couples, and seniors.
It’s worth keeping your eye out for these offers so you can claim sooner rather than later on health services.
Does Medicare cover the cost of physio?
Generally, physiotherapy costs are not covered by the federal government’s Medicare. There are a few exceptions where Medicare will provide benefits for physio-related services.
1. Public hospital admittance
For patients requiring physio or rehabilitation whilst they are in a public hospital, Medicare provides some benefits. It’s likely they won’t cover you for ongoing treatments delivered outside of the hospital.
2. Chronic Disease Management
For patients who are requiring physio-related treatments as part of their Chronic Disease Management, Medicare may provide benefits. Some of the eligible diseases include diabetes, arthritis, cancer, stroke, and certain musculoskeletal conditions. To receive Medicare benefits, the treatment must be recommended by a GP and at least two allied health professionals. An overview of eligibility and requirements for Chronic Disease Management can be found here, including how the referral works with allied health professionals.
Other benefits you can enjoy with extras coverWhile it’s one of the most popular benefits Aussies enjoy, physiotherapy isn’t just the only service you can claim under extras cover. Depending on your fund and the level of cover, you may be able to enjoy the benefits of:
Key factors to consider when you’re comparing extras coverComparing extras cover couldn’t be any easier with our online comparison tool. While price is an important factor to consider, it’s not the only feature of health insurance you should take into account. When you’re considering extras cover, here are a few additional factors to consider:
Consider the health of you and your family
Compare the percentage or set benefit
Know the limits
Turning 31 soon?
Now you know what to look for, you should feel confident you’ll be able to compare extras insurance matching the best policy to your health care needs. It’s quick and easy to do with our online comparison tool.
Have more questions before you take out a policy? Give our experienced team a call on 1300 806 119. They’ll be happy answer any queries you have and help you find the ideal physio cover for your needs and budget.
1. Which Australian insurance company is best for physio cover?
The best insurance company for physio cover can vary depending on individual needs and preferences. However, some popular insurance providers in Australia that offer comprehensive physiotherapy coverage include Medibank, Bupa, NIB, HCF , and Australian Unity. It's recommended to compare their policies, benefits, and pricing to determine which one aligns best with your specific requirements.
2. What is HICAPS?
HICAPS stands for Health Industry Claims and Payments Service. It is an electronic health claims system widely used in Australia by healthcare providers, including physiotherapists. HICAPS allows for efficient and convenient processing of health insurance claims and payments at the point of service. With HICAPS, you can swipe your health insurance card, and the system instantly checks your coverage, processes the claim, and calculates any out-of-pocket expenses. It simplifies the payment process and reduces the need for manual claim submissions.