Your Feet & Ankles Carry You Through Life – It’s Time to Start Taking Care of Them with Health Insurance for Podiatry and Orthotics
Taking care of your foot and ankle health is essential, and having the right insurance coverage can make a significant difference. Whether you're dealing with a specific foot condition, injury, or require orthotic devices to enhance your mobility and comfort, finding a suitable health insurance plan is vital.
In this comprehensive guide, we’ll provide you with all the essential information you need to make an informed decision about your health insurance options for podiatry and orthotics. We'll help you navigate through the complexities and understand the key factors to consider when selecting a health insurance plan that best suits your needs.
By the end of this guide, you'll have a clear understanding of how health insurance can support your foot and ankle health journey. Armed with this knowledge, you can confidently select a plan that not only meets your specific needs but also provides you with peace of mind knowing that your podiatry and orthotics requirements are well taken care of.
Health Insurance Cover Options for Podiatry & Orthotics Care
Podiatric surgery and general consultations can be performed in various healthcare settings, such as private practices, community health centres, day surgery centres, and certain private and public hospitals across Australia. To ensure you have adequate cover from a health fund, here's what you should look for:
Combined Cover: Private health funds typically cover around half the cost of your treatment, but you'll need both hospital cover and extras cover (also known as Combined Hospital & Extra Cover).
Rebates for Podiatric Surgical Services: Some funds offer rebates for surgical services provided by podiatrists aligned with the Australasian College of Podiatric Surgeons (ACPS). These rebates can help cover theatre fees, bed stays in private hospitals, and the costs of implantable prosthesis like pins, screws, and plates.
Orthotics Health Insurance
Are orthotic services covered by health insurance?
The good news is that many Australian private health funds include cover for orthotics as part of their extras policies. However, to receive benefits for orthotics, you will usually need to have a comprehensive extras cover since basic extras policies often exclude them.
It's important to note that health funds may classify orthotics differently. Some funds have a separate section for orthotics with a single annual benefit limit that covers orthoses and treatment by an orthotist. Others may combine orthotics with other appliances under a health aids category with a shared annual benefit limit.
Does Medicare Cover Podiatry & Orthotics Care?
Under the Australian Medicare system, professional fees for medical practitioners undertaking foot surgeries are rebated. However, these rebates don't typically apply to podiatric surgery. Medicare may cover a percentage of your podiatry fees if you have a referral from your GP and are on an Enhanced Primary Care (EPC) Plan.
To be eligible for Medicare rebates in these cases, you usually need to fall into one of the following categories:
- Being a chronically ill patient
- Having diabetes
- Suffering from vascular disease
Keep in mind that Medicare rebates may only apply to the consultation fee, and any additional services will incur out-of-pocket expenses.
Are Orthotics Covered by Medicare?
Medicare doesn’t cover the cost of any type of orthotics treatment or care. This is why many people opt for private health insurance, which can help with costs like footwear modifications and orthotics, making it easier to manage the overall expenses of their treatments.
How is Podiatry & Orthotics Covered Outside of Hospital Insurance?
While hospital insurance typically covers podiatry surgery, comprehensive extras plans provide coverage for podiatry care outside of the hospital setting.
To access this coverage, you'll need a mid-range or high-level policy, such as gold, which offers rebates for podiatry appointments outside of the hospital.
Orthotics care, on the other hand, is only covered under extras cover.
Could You Benefit from Seeing a Podiatry & Orthotics Specialist?
There are a range of reasons why you might need to see a podiatrist or orthotic specialist. Here are just a few:
- Structural deformities: Conditions such as bunions, hammertoes, painful flat feet, and high arch deformities can cause discomfort and affect mobility.
- Heel pain: Conditions like plantar fasciitis, Achilles tendonitis, and heel spurs can cause persistent heel pain and affect daily activities.
- Nerve entrapments: Conditions like Morton's neuroma or tarsal tunnel syndrome can cause nerve compression, leading to pain, numbness, and tingling sensations.
- Joint degeneration and arthrosis: Conditions such as osteoarthritis in the foot and ankle joints can cause pain, stiffness, and limited range of motion.
- Skin and nail conditions: Podiatrists can help with issues like ingrown toenails, fungal infections, corns, calluses, and warts.
- Congenital deformities: Some individuals may have foot and ankle deformities present from birth, such as clubfoot or flat feet.
- Trauma-related injuries: Fractures, dislocations, and post-traumatic arthrosis resulting from foot or ankle injuries may require specialized care.
- Orthotic needs: Orthotics can be helpful for conditions like biomechanical imbalances, excessive pronation, or specific foot and ankle alignment issues.
- Rehabilitation: After surgeries, injuries, or conditions that affect foot and ankle function, podiatrists can assist in the rehabilitation process.
- Pain management: Persistent foot and ankle pain that affects quality of life can be evaluated and treated by podiatrists or orthotists.
Orthotists Vs Podiatrists – Are They the Same?
While both are health professionals and there are some similarities in their work, it's important to note that orthotists and podiatrists are two distinct types of healthcare professionals.
Orthotists: These professionals specialize in working with orthoses, which are external devices used to treat various physical limitations caused by illnesses, disabilities, and deformities. Orthotics are often used to address abnormalities, prevent injuries, and improve the normal functions of the lower limbs and feet.
Podiatrists: On the other hand, podiatrists focus specifically on disorders and conditions affecting the lower limbs. While podiatrists may occasionally prescribe and fit orthotic devices, their expertise extends beyond that. They also provide palliative treatments like removing calluses, warts, corns, and ingrown toenails to promote foot health and comfort.
Important Considerations When Claiming Orthotics & Podiatry
When it comes to claiming orthotics and podiatry services, there are a few key considerations to keep in mind. Here's what you should know:
Recognised provider: Before submitting a claim for orthotic appliances, ensure that they are provided by a registered orthotist, orthotic supplier, or podiatrist. It's important to check if your health fund covers orthotics purchased from your chosen supplier before making any payments.
Waiting periods: Take some time to understand the waiting periods that apply to orthotics under your policy. Some health funds have a general waiting period for all orthotics claims, which could be around 12 months. However, specific waiting periods may be imposed for repairs, maintenance, hiring, and replacement of orthotic equipment. Carefully review the details in your policy to avoid any surprises.
Annual benefit limits: Check the benefit limits associated with your cover. Apart from an annual limit for orthotics, your health fund might have specific limits for certain orthotic devices or agree to cover a percentage of the cost for particular orthotic appliances. It's important to remember that the annual limit mentioned may also include benefits for other health aids and appliances.
Ready to Find the Right Health Insurance Cover for Podiatry and Orthotics?
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FAQs
What is podiatry treatment?
Podiatry treatment helps with medical issues linked to the feet or lower limbs. This can include joint disorders like rheumatoid arthritis, as well as soft-tissue and muscle conditions. It can also include different types of neurological and circulatory diseases.
How do podiatric service costs work with private health funds?
Essentially, it's no different to other services included on a private health plan. If podiatry services are included in your hospital policy, your health funds are required to pay the minimum default benefit for your treatment. If your surgery goes over this cost, you'll have to pay the difference.
Can I lodge a claim on the spot for orthotics?
Unfortunately, the HICAPS electronic claiming system is not yet available for use by orthotists in Australia. You will instead need to forward your receipt onto your health fund to ensure that your claim is processed.
Which Australian health funds cover orthotics?
There are several Australian health funds that cover orthotics, including Medibank, HCF , Bupa and more.
Can I visit a physiotherapist for podiatry and orthotics?
While physiotherapists specialise in treating musculoskeletal conditions, including those related to the lower limbs, they may not have the specific expertise in podiatry and orthotics. It's best to consult with a podiatrist who can provide specialised care for foot-related issues. If you need physio cover, head here.
What is a biomechanical assessment in podiatry and orthotics?
A biomechanical assessment is a comprehensive evaluation of the structure, alignment, and movement patterns of the lower limbs and feet. Podiatrists perform this assessment to identify any biomechanical abnormalities that may contribute to foot pain or dysfunction. It helps in determining the need for orthotic devices or other treatment options.
Are custom orthotics covered by health insurance?
Health insurance policies often provide coverage for custom-made orthotics inserts, which are specially designed and manufactured to address specific foot conditions. However, the extent of coverage may vary depending on your policy and the level of cover you have. It's advisable to review your policy details or contact your health fund to understand the coverage for custom orthotics.
