Private health insurance for physiotherapy

Yes, an extras policy (which pays a benefit towards some out-of-hospital services) can contribute towards your physiotherapy costs up to the limits outlined by your insurer. Depending on your level of cover, a hospital cover policy may also pay towards physiotherapy costs that you incur as a hospital inpatient.

Keep in mind that you’ll typically need to serve a waiting period before you can claim physiotherapy on health insurance. For further information, read through your policy brochure to understand what is and isn’t covered and whether any limits apply.

Your extras health insurance can cover the cost (up to the limits of your policy) of initial physiotherapy consultations, follow-up consultations, treatment plans and rehabilitation.

Some extras policies will also cover other physiotherapy treatments and products, like:

• Antenatal therapies for pregnant women
• Compression wear
• Dry needling
• Electrotherapy
• Group classes
• Hydrotherapy.

However, your physiotherapy appointment must be performed by an accredited physiotherapist or a recognised extras provider if you wish to claim a benefit from your health fund. As such, make sure you visit a physiotherapist that your insurance will cover.

The length of time you’ll have to wait to claim for your physiotherapy treatments depends on your health insurer and policy, as each insurer sets their own waiting periods for extras cover. However, physiotherapy typically has a two-month waiting period before you can claim benefits on your extras cover.²

Some policies may have longer waiting periods; others may have no waiting period for physiotherapy on select policies or run promotions that waive some waiting periods for extras. If you’ve already served your waiting period, you don’t have to do so again when switching policies, provided you maintain the same or lower level of cover.

As for how many physio sessions you can claim per year, the amount will vary from product to product. If you want to learn more, you should start shopping around.

Health insurance generally only covers physio treatment performed by a physiotherapist that’s accredited, qualified, allied or registered through the Australian Health Practitioner Regulation Agency (AHPRA).

Furthermore, some health insurers may encourage you to seek physiotherapy treatment through a provider that they have an arrangement with.

If this is the case, you should speak to your health fund about your physio treatment before making an appointment to ensure you’re getting the best value out of your policy.

The cost of physiotherapy depends largely on the type of treatment you receive and the clinic you visit.

However, the national regulatory body for worker’s compensation, Comcare, does provide physiotherapists with a guide to their recommended upper limit fees. This only acts as a guide; the cost of your physio may be different to the prices outlined below.

The amount you can claim on your health insurance extras policy for physio services depends on your policy’s benefit type. The two benefit types are:

• Percentage benefits: Covers a percentage of your treatment costs.
• Set benefits: Covers up to a dollar amount for each initial or subsequent visit.

Your health insurance policy will provide coverage up to an annual limit, which is the maximum amount you can claim specifically for physio each year. Physiotherapy cover may also be subject to a group limit, which is when services are grouped together and you have a limit to use on any of them.

For example, say your policy groups physiotherapy, chiropractic and acupuncture with a $500 group limit. If you spend all $500 on chiropractic, you’ll reach your group limit and won’t have any money left to claim on physiotherapy or acupuncture services.

Your limits will be renewed each membership, financial or calendar year depending on your insurer, although some policies will also have lifetime limits that you may need to be aware of.

Swiping your insurance health care card through your physiotherapy clinic’s HICAPS machine is the quickest and easiest way to claim. Otherwise, after paying for your treatment, you can submit a claim to your insurance company to reimburse some of the costs; make sure you keep proof of payment (e.g. receipts).

Remember that you may need to pay for some costs out-of-pocket if your physio charges you more than your policy covers. These out-of-pocket expenses are also known as a gap payment. Check your policy brochure to determine how much your policy lets you claim on treatment.

Some health insurers may impose a time limit for extras claims, so don’t wait too long before submitting your claim.

Physiotherapy works by assessing your condition and treating your physical problems through body massage, joint manipulation and muscle stretches. This treatment can also help reduce the chances of future injuries and improve quality of life.

Some conditions that physiotherapy can potentially help treat include:³

• Aches
• Arthritis
• Back and knee pain
• Children with developmental delays or movement problems
• Incontinence
• Injuries
• Neurological conditions (e.g. Parkinson’s disease)
• Occupational health (i.e. job-related injuries)
• Recovery and rehabilitation after broken bones or surgery
• Sprains

Physiotherapy may involve multiple visits to the specialist. As a result, the costs can add up over time. Physiotherapy cover could help pay for regular physio treatments up to the limits of your policy.

Money aside, physiotherapy could do wonders for your quality of life. Physiotherapists have unique skills and clinical expertise to evaluate and educate people with chronic pain. With these skills, physios can guide patients through a supervised exercise program to help improve function and quality of life.

Alleviating pain and discomfort can be enormously valuable to many Australians, making these treatments very appealing.

You might want to consider purchasing health insurance if you regularly need to visit the physiotherapist. Physiotherapy cover could help pay for regular physio treatments, which you may need if you:

• Have a neurological or movement disorder
• Are recovering from an accident or injury
• Suffer muscle or back pain
• Are an athlete or play sport (read more about health insurance for sports injuries)
• Work in a physical job or have an active lifestyle.

For example, let’s say you have some persistent tightness in your calf muscles after work. It’s not a medical emergency, but a quick consultation with a physio may provide a simple solution.

However, if the pain persists, you may need to have follow-up sessions, which you’ll have to pay the full cost for out of your pocket if you don’t have health insurance with physiotherapy cover.