Introduction to Private Health Insurance in Australia

Understanding Private Health Insurance

Private Health Insurance in Australia provides individuals with the option to receive healthcare services outside the public system. It offers coverage for services not fully covered by Medicare, such as dental, optical, and certain Allied Health Services.

Medicare. Is Hypnotherapy covered by Medicare? Private Health Insurance Rebate

It's important to remember that Private Health Insurance and Medicare are two different things in Australia. Medicare is government-funded, while private companies and superannuation funds offer private health insurance. It is optional to take out private health insurance - if you have not taken this out, there is no need to read on as you will need to pay full price for Allied Health and Natural Therapy Services.

When taking out Private Health Insurance, potential policyholders can choose from a variety of coverage levels and benefits, tailoring their insurance to their health needs and lifestyle preferences. This flexibility allows Australians to access a broader range of healthcare services, potentially reducing wait times for treatments and providing access to private hospital care.

How Private Health Insurance Works

When you purchase a private health insurance policy, you pay a premium to your chosen insurance provider. In return, you receive coverage for healthcare costs that are not fully covered by Medicare, Australia's public healthcare system.

The specifics of what is covered will vary depending on your policy, including whether it includes hospital cover, extras cover, or both. Hospital cover pays towards the costs of in-hospital treatment, while extras cover pays for out-of-hospital treatments such as physiotherapy, dental, and optical services.

Many Australians choose to have both types of cover to ensure comprehensive health protection.

Claiming the Private Health Insurance Rebate

To claim a rebate under private health insurance for eligible services, you typically present your insurance card at the time of treatment. Many healthcare providers, including Brisbane Livewell Clinic, offer on-the-spot claiming through HICAPS (Health Industry Claims and Payment Service), allowing you to receive your rebate immediately and pay only the gap amount.


Hicaps Machine. Health Insurance Provider Rebate

It's important to check with your insurance provider to ensure your Allied Health Service or Natural Therapy Service is covered under your policy, so you know going into your consultation with us. We unfortunately do not have all the necessary information about your own Health Insurer and your Policy, so we can only help you with general enquiries. You will need to call your Health Insurance Provider for more specific enquiries about your own policy and whether you are eligible for a particular healthcare service.

Can I Claim My Private Health Insurance Rebate on the spot in your Clinic?

Many Health Insurance Funds allow on the spot claiming. Here is a list of some of those that may allow this type of claiming (although we recommend you check with your own Health Insurance Provider to make sure, as this information may no longer be current when you read it):

Health Insurance Funds for On-the-Spot Claims through HICAPS

Australian Health Management (ahm): Visit ahm

Australian Regional Health Group and its members:

BUPA Australia Health: Visit BUPA

NIB: Visit NIB

Medibank Private: Visit Medibank Private

The Doctors’ Health Fund: Visit The Doctors’ Health Fund

HCF: Visit HCF

Australian Unity: Visit Australian Unity

Grand United Corporate Health: Visit Grand United Corporate Health

For a complete list of all Australian private health insurance funds and to find the one that best suits your needs, including those not listed here, please refer to the official Private Health Insurance Ombudsman's website.

If your Health Insurance Fund does not allow on-the-spot claiming, you will need to pay in full on the day of your consultation and then submit your invoice/receipt to your Insurance Provider to claim your rebate. This process may take one or more weeks for you to receive your rebate.

Where to get more Information

For more detailed information on private health insurance and its benefits, visit the Australian Government's Private Health Insurance Ombudsman website  and PrivateHealth.gov.au. These resources offer comprehensive guides on choosing a policy, understanding your coverage, and making informed decisions about your health insurance needs.

Commonwealth Ombudsman. Private Health Insurance Rebate
PrivateHealth.gov.au Private Heath Insurance Rebate


Services at Brisbane Livewell Clinic and Their Claimability

At Brisbane Livewell Clinic, we offer a range of Allied Health Services and Natural Therapies that may be claimable under private health insurance, depending on your policy. Services such as acupuncture, physiotherapy, dietetics, and nutrition are often covered under the extras component of private health insurance policies.

However, the claimability of specific services can vary significantly between different insurance providers and policies. It's essential to consult with your insurance provider to confirm which services are covered under your policy.

Claimable Services (depending on your private health insurance policy)

Note: You may be able to claim some Physiotherapy and Dietician consultations under Medicare - you will need to obtain a health care plan from your GP first.

Services Potentially Not Covered (depending on your private health insurance policy)

Some natural therapies and holistic treatments may not be covered by private health insurance policies, including: 

From 1 April 2019, Private Health Insurance Funds ceased to provide benefits for a number of Natural Therapy Services due to changes to Section 121-10 of the Private Health Insurance Act 2007 which excluded those Natural Therapies from the definition of private health insurance general treatment. These included Alexander technique, Aromatherapy, Bowen therapy, Buteyko, Feldenkrais, Western herbalism, Homeopathy, Iridology, Kinesiology, Naturopathy, Pilates, Reflexology, Rolfing, Shiatsu, Tai Chi, and Yoga. You can still access these Natural Therapies, but unfortunately will be unable to receive a Private Heath Insurance Rebate for them.

It's crucial to verify the coverage of specific Allied Health and Natural Therapy services with your insurance provider, as Brisbane Livewell Clinic is required to charge you the full fees if your Private Health Insurance does not cover that service.

Can I still see a Practitioner if that Service is not Claimable?

If your chosen service is not covered by your private health insurance, that's not a problem - you can still attend and see your Practitioner.

You will just need to pay the amount in full on the day of your service, and you will not receive a rebate. So make sure to budget for this payment as required. 

Step-by-Step Guide to Claiming Private Health Insurance Rebates

  1. Choose a private health insurance policy that covers allied health services and natural therapies.
  2. Ensure your chosen services at Brisbane Livewell Clinic are covered under your policy.
  3. Book a consultation with a practitioner at Brisbane Livewell Clinic.
  4. Attend your consultation.
  5. At the end of your session, use the HICAPS machine at the Clinic to claim your rebate instantly.
  6. The rebate amount will be deducted from the total cost, and you will pay the gap.
  7. If the HICAPS machine is not working or if you are not eligible for on the spot claiming, pay the full amount and retain your receipt. Claim the rebate directly from your insurance provider.

It's important to note that each health insurance fund has its own rules regarding rebates for allied health and natural therapies. Rebates vary between funds, and not all services may be covered. Patients are encouraged to make enquiries with their insurance provider to understand their own specific coverage.

Maximising your Benefits

By familiarising yourself with the workings of private health insurance in Australia and the specific coverage details of your policy, you can maximise the benefits available to you at Brisbane Livewell Clinic.

TIP: Pay particular attention to when your limits under your policy reset. Some reset on 1 January each year, while others reset on 1 July. This may help when scheduling your next consultation - eg booking an appointment for 2 July rather than 30 June may mean you can claim a rebate for that appointment if your policy's limit resets on 1 July of that year.

Whether for preventive care, support of specific health conditions, or general wellness support, it's important to understand your health insurance coverage to get the best out of your private health insurance policy.

FAQs

1. What if the HICAPS machine isn't working when I tap my card?

If the HICAPS system is down, you'll need to pay the full amount upfront at our Clinic. Keep your receipt to claim the rebate directly from your health insurance provider.

2. What is the gap?

The gap refers to the difference between the total cost of your consultation and the amount covered by your private health insurance rebate.

3. What happens if a practitioner does not have a provider number for the clinic?

If a practitioner lacks a provider number for the Clinic, you may not be able to claim a rebate for their services until after they have obtained that provider number. It's crucial to verify the practitioner's eligibility for insurance claims before your appointment.

4. Can I claim a rebate for any service at Brisbane Livewell Clinic?

Rebate eligibility varies by insurance fund and policy. Check with your provider to confirm which services are covered. We have listed above our understanding of the services you may (or may not) be able to claim.

5. How do I know if my insurance covers natural therapies?

Review your insurance policy details or contact your provider directly to determine coverage for natural therapies.

6. Is there a limit to how much I can claim for allied health services?

Most insurance policies have annual limits for different types of services. Check your health policy for specific limits.

7. Can I claim a rebate for services received from multiple modalities at Brisbane Livewell Clinic?

If your insurance policy covers multiple disciplines and you haven't exceeded your annual limits, you could potentially claim a rebate for services received from multiple modalities at Brisbane Livewell Clinic.

8. How long does it take to receive a rebate after claiming?

With HICAPS, rebates are processed instantly. If claiming manually, it may take several days to weeks, depending on your provider.

9. What should I do if my claim is rejected?

Contact your insurance provider to understand why the claim was rejected and if there's any additional information you can provide. Keep in mind that there may be some time limits on claiming, although these are often years rather than weeks.

10. Can I claim a rebate for products purchased at Brisbane Livewell Clinic?

Product rebates depend on your insurance policy. Some policies may cover products prescribed by your practitioner, however this is rare and the best approach may be to assume that products will not be covered. Check with your health insurance provider to make certain.

New Supplements in store at Brisbane Livewell Clinic. Naturopath Queensland

11. What information do I need to provide for a rebate claim?

Generally, you'll need to provide your full name, policy number, and the receipt from your treatment.

12. Are there any conditions on claiming rebates for natural therapies?

Some insurers may require a referral (although this is rare), or they may limit claims to certain types of natural therapies. Check with your provider.

13. What happens if I exceed my annual limit for a particular service?

Once you exceed your annual limit, you'll be responsible for the full cost of any additional consultations until your limit resets. You will simply receive a "payment declined" notice on your card when you go to claim for a consultation in an amount that exceeds your annual limit.

14. Can I use my rebate for a future treatment?

Rebates cannot be applied to future treatments. They are only applicable to the cost of services already received.

15. What if I change my health insurance provider?

If you change providers, check your new policy's coverage for allied health services and natural therapies, as it may differ from your previous coverage. Make sure you check if there is any waiting period or wait period (within which you won't be eligible to claim a rebate).

Last Updated on 31 March 2024 by Brisbane Livewell Clinic