Medicare: The Good, the Bad, the misconceptions and the rest

Many people are not aware that Medicare subsidises up to a total of 5 visits per calendar year for qualifying patients to seek assistance from Allied Health professionals such as Physiotherapists and Exercise Physiologists.  In this article I am going to tell you about about the services that we cover here at Fizzio for Life and Well over 40, the limitations of Medicare funding and some ways we are trying hard to be able to continue to provide a bulk-billing option for our patients.

The Good:

1:  As mentioned above, up to five allied health visits a calendar year can be available to qualifying patients (the complete rules can be found here if you suffer from insomnia!).  To qualify you need to have a chronic medical condition that has been present (or is likely to be present) for at least six months or have a terminal illness.  Your GP is the ONLY person who can determine your suitability and prepare a Chronic Disease Management plan.  Once your GP has determined your eligibility they may share the five visits between different allied health team members such as a physio, an EP, or a dietician – which ever they feel is the most relevant.

2:  If you identify as Aboriginal or Torres Strait Islander, you may also be able to access a further five visits.

3:  If you suffer from Type 2 Diabetes, you may also be eligible for group allied health services which include an extra individual appointment with an EP, Dietician or Diabetes Educator, and up to 8 group sessions with one of these allied health professionals.  At Fizzio for Life, we offer Exercise Physiology appointments and bulk-billed group exercise programs under this referral.  Your eligibility and referrals need to be organised by your GP.

4:  Some allied health practitioners may bulk-bill these visits.

The Bad:

1:  Up to five visits is RARELY enough to resolve a chronic condition.  They are designed to make the episode of care more affordable and accessible, and our therapists will definitely give you some tools to self manage and some pain relief, but overall the nature of chronic conditions means that TCAs are not generally sufficient on their own to resolve long term issues.  The best way of thinking about them is as a stepping stone to getting your health on track.

2:  The Australian Government has not raised the fee for Medicare funded appointments since 2012 (7 years).   If your practitioner bulk bills they are paid the princely sum of $52.95 per visit.  The fees have been frozen, despite huge increases in providing services such as rent, wages, CPI increases, and electricity.   Unfortunately this has resulted in the growth of 20 minute consultations (the allowable consult time under Medicare legislation), incentivises some practitioners to see more than one patient at a time, and discourages clinicians from operating in independent clinics where they can have superior facilities due to the costs involved.  There is nothing illegal about any of these options, however, it is not the level of care that we like to offer at Fizzio for Life.

3:  It doesn’t look like the rates will be lifted anytime soon which will continue to make it harder for clinicians to offer bulk billed services.

4:  Medicare doesn’t differentiate between the levels of knowledge and speciality that your therapist is providing. They do not recognise if your allied health provider has spent years accumulating knowledge and perfecting their skills, for example.

The Misconceptions:

1:  Medicare is a tightly regulated service.  We are not in charge of the rules, and cannot control if you qualify for this service.

2:  There are only a total of 5 combined allied health visits available per calendar year – not 5 for each kind of therapy.  If you don’t use the number allocated to you on that referral in the calendar year, they do remain valid into the next year, however they do not accumulate.  For example if your doctor gave you 5 allied health visits in 2018 and you only used two, then you can continue to use that referral into 2019 for another 3 visits without going back to the GP.  However, when they are finished and you go back to your GP, even if they write 5 on your next referral, you will still be only able to use 2 in the 2019 calendar year.  Complicated I know, but that’s Medicare for you!

3:  Medicare will only pay for 5 allied health visits between 1 January and 31 December – no exceptions – except as listed above for referrals for Type 2 Diabetes, or Aboriginal and Torres Strait Island Health plans.

4:   Bulk-billed sessions aren’t ‘free’. They are paid for by the tax payers of Australia and are a privilege, not a right!  Regardless if your doctor says they are ‘free,’ it is up to each individual provider whether or not they are able to accomodate this given their circumstances.

The rest:

At Fizzio for Life, we recognise that there are many people in our community that are unable financially to access physiotherapy and exercise physiotherapy services.  Despite the Government’s freeze, we remain committed to offering accessible care without dropping our standards.  However as we provide all of our patients with a minimum of 30 minute quality one-on-one appointments we have had to make some changes to enable us to keep delivering bulk billed services.

Our 2019 Bulk billing policy is:

1:  Half hour appointments – min:  We continue to see every patient for a minimum of half an hour, regardless of payment type,  because we believe in caring for our patients.  This means we are actually treating our bulk billing patients for free for 10 mins of their consultation!

2:  Week day appointments:  The majority of our physiotherapists remain bulk billing on week days if you have a qualifying Team Care Arrangement and referral from your GP.  Our physios are all wonderful therapists and mentored closely by our senior physiotherapists.  Our Exercise Physiologists remain bulk billing with the exception of our Senior EP, Michael.

3: Weekends:  If you have a TCA and can only make weekend appointments you can still use your care plan, however, we are unable to sustain bulk billing on  weekends due to the rising cost of wages/penalty rates.  The simple process is that you pay the appointment fee in full and then we will process a $52.95 rebate back into the bank account you have registered with Medicare.  You don’t need to do anything!  This is a legal requirement from Medicare and is designed so your fee is added to your Medicare Safety Net – unfortunately we can’t just get you to pay the ‘gap’ like you can with your private health.

4:  Senior Physiotherapists:  Our Senior Physiotherapists, Michael (who is also our Senior Exercise Physiologist) and Julie, have years of experience and specialised training.  To recognise their experience, you can still use your care plan, however they are not bulk-billing from 2019, with the exception of some women’s health appointments with Julie.  They are more happy to help you if you have a team care arrangement, and would rather see a senior therapist, it’s just the same procedure as above – you just need to pay for your appointment in full and we will process your rebate for you to avoid you needing to deal with Medicare.

5:  Longer initial appointments:  You can choose a longer 45 minute initial appointment with all of our therapists even if you have a TCA – in fact we encourage this so that we have enough time to do your assessments, diagnosis, and some significant treatment. However, as Medicare pay for 20 minute consultations, you can still use your care plan however it is not possible for us to bulk bill this appointment.  The same thing applies – Medicare rules are that you must pay for your total appointment as per our private fees, and then we will do an electronic rebate for you.  This is also true if you have a one hour Women’s Health appointment.

6:  Other care:  We will always continue to offer lower cost options for care where ever possible, for example the free “My Health for Life program,” free public education seminars, and low cost exercise options.

If you have any questions or need any clarification you are always free to contact our office on 38053223 or email  Thank you for your support of our clinic and your understanding.