Health Insurance with Physio Cover

23 January 2019
Have ongoing pain? Recovering from an injury? Some health insurance extras policies offer physiotherapy cover, which you can learn more about here.

Health insurance policies with physiotherapy cover

The table below displays a snapshot of hospital & extras policies which offer cover for physiotherapy on Canstar’s database with links to providers’ websites, sorted by Star Rating and then by provider name (alphabetically). Please note the results are based on a young couple (aged under 35) living in NSW. Before committing to a particular policy, check upfront with your provider and read the PDS to confirm the details of the physiotherapy cover available and whether the policy as a whole meets your needs.

What is physiotherapy cover?

Physiotherapy is treatment that aims to help people move more freely and with less pain by using physical methods such as massage and exercise rather than drugs or surgery. Physiotherapy cover is an extras inclusion under some health insurance policies in Australia that can provide benefits when you see a physiotherapist.

Taking out a reliable health insurance extras policy to cover your physio needs could be worth considering if you are prone to or likely to suffer from any of the following:

  • Movement disorders
  • Recovery following an accident or injury
  • Certain chronic illnesses
  • Neurological disorders
  • Back and neck pain
  • Sports injuries

Bear in mind that these are just some examples of things that physio cover could include – the exact types of treatments that are covered will depend on your policy.

What’s included under physio cover?

Typically when you take out an extras policy with a physiotherapy inclusion, you could be covered for benefits that help you pay some or all of the costs incurred by out-of-hospital physiotherapy treatment.

What and how much you’re covered for will depend on your insurer and what level of cover you have. A basic policy may have very limited coverage available, while more expensive policies will typically have more extensive cover.

By way of example, if you have a health insurance extras policy with physiotherapy cover you may be able to claim for some or all of the following physio services:

  • An initial consultation and health diagnosis
  • Follow up consultations
  • The development of treatment plans
  • Rehabilitation
  • Dry needling

Can I claim on physio cover?

Depending on the type of extras policy you have with a physiotherapy inclusion, you will typically be eligible for one of the following types of cover:

  • Percentage benefits: under this benefit structure your rebate will take the form of a percentage (e.g. 50%) of the fee you’re charged for eligible claims
  • Set benefits: this sees your rebates come in a fixed dollar amount for each claim, such as $45.

How to claim

Claiming on your health insurance for physio visits can be a simple process. The exact steps involved may vary depending on your insurer, but you can generally:

  1. Present your private health insurance card at the front desk prior to your session
  2. Receive your ‘item number’ after the session is completed
  3. Lodge your claim either through your provider’s app, their online claims service, via email, fax, mail or in person, depending on your policy and your preferred method of lodging a claim. You’ll usually need to quote both your policy number and your item number.

Annual limits usually apply to the amount you can claim on physiotherapy –higher levels of cover will generally come with a higher annual limit.

Is physiotherapy covered by Medicare?

In most cases, Medicare does not cover out-of-hospital physiotherapy. However, Medicare should cover public hospital admittance for patients who need in-house treatment or rehabilitation. You are also covered for five sessions related to chronic health conditions (such as arthritis) in a calendar year (valid at the time of writing).

Waiting periods for physio claims

Waiting periods – the amount of time you need to wait after taking out a policy before making a claim – are set by health insurers, not the government. Because of this, waiting periods will vary from insurer to insurer. According to the Private Health Insurance Ombudsman, the average waiting period for physiotherapy is about two months.

Once you sit out these waiting periods, you can start claiming on physiotherapy treatment with your health insurance provider. Sometimes, an insurer will waive the waiting periods for general treatments such as physio and general dental in special circumstances. You’ll have to read the PDS (Product Disclosure Statement) of your policy or contact your insurer to find out what these are.

There are also special signup deals on offer by various providers that can remove waiting periods if you apply before a certain date. However, as always, we’d encourage you to weigh up the price and features of a particular policy before making a decision.

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