If you are living in Australia and need to see a physiotherapist, it is important to understand how the health insurance system works. In this blog post, we will discuss the different types of health insurance policies available in Australia, as well as the process for claiming physiotherapy expenses. We will also provide some tips on how to find a good physiotherapist and get the most out of your treatment.

Private health insurance

Most people in Australia will need to take out private health insurance. There are two different types of cover – hospital cover and extras cover. Hospital cover helps pay for the cost of private hospital treatment or surgery. Extras cover helps pay for the cost of services like dental, physiotherapy, chiropractic and optometry.

Hospital cover

Hospital cover can be useful in cases of an extreme emergency, as it will help pay for the cost associated with a hospital stay. In most cases, you will need to pay an excess fee when you are admitted to the hospital. The excess is the amount that you agree to pay towards your treatment and is generally between $500 and $1000.

Ambulance cover

Ambulance cover is one of those things that you don't really think about until you need it. And when you do need it, you really need it. Unfortunately, ambulance cover is not uniform across Australia. Each state and territory has its own rules and regulations regarding ambulances cover.

physiotherapy health cover

Most health insurance companies will cover part of the physiotherapy service fee. The amount they pay varies greatly and can be anywhere from $20 to $100, depending on the amount of coverage. The standard amount paid is around $40 per appointment. However, it is important to check with your individual health insurance company to see what coverage they provide. At the time of writing this article the standard physiotherapy appointment costs around $120 so your gap fee is anywhere from $20 -$100.

There is no standard number of sessions that are covered by physiotherapy extras covered as part of your private health insurance. However, typically you get a maximum of eight sessions. So not only do they partially cover the appointment costs they don't cover all appointments. This can be frustrating and leave you feeling like you have to choose between getting the full treatment you need or using your limited number of covered sessions. If you find yourself in this situation, it's important to remember that there are other options available to help pay for physiotherapy. You can look into government rebates, Medicare-funded services, or even negotiating a payment plan with your physiotherapist. Whatever route you decide to take, make sure you get the treatment you need to reach.

How do you access the physiotherapy rebate?

The HICAPS terminal is an easy way to access your physiotherapy rebate, however, you can also claim online via your health insurance company directly. This process is simple and straightforward and will allow you to receive your rebate quickly and easily. At the time of this article, the HICAPS terminal isn't mobile - therefore if you need homecare you need to manually claim via your health insurance online portal. The HICAPS terminal needs to be plugged into an ethernet router which is a great source of frustration for homecare providers. However, as mentioned you can still submit invoices online.

Preferred provider schemes!

Preferred provider schemes are a type of health insurance in which the insurer has a contract with certain providers, usually healthcare professionals or facilities, to provide services to policyholders at a discounted rate. These contracts typically stipulate that the provider will not bill the policyholder for any amount over the agreed-upon fee. Preferred provider arrangements are common in Australia. The problem is these providers are often forced to give shorter appointments to compensate for the less money paid by the insurance companies. In my opinion complex injuries require appointments at least 60 minutes duration. Preferred provider follows up appointments are usually 20-30 minutes.

Which health insurance is best?

There is no easy answer to this question. It depends on a variety of factors, including your individual needs and circumstances. You'll need to carefully consider what works best for you and your family. Think about the injuries that are most likely to occur, and look at the numbers to see how much each insurance company will pay out in each scenario. Only you can decide which health insurance is best for you.

What happens if I don't have insurance?

If you don't have health insurance you can still access private physiotherapy services in Australia. Most private clinics will take regular clients without insurance. There is no difference in fees or anything like that. The only advantage of having health insurance covers they will pay a small gap payment. However, there is an argument that sometimes the total cost of the premium is less than the gap payments provided.

If you don't have insurance and you need surgery or a hospital stay and it can be more of a problem. Typically these fees are much greater than anything provided by physiotherapists. If you, unfortunately, needed a private surgery for a knee reconstruction or ankle fracture or something like that it can be very expensive.

Is more expensive better?

More expensive health insurance is not always better, however, it typically is. The more you pay for health insurance the higher the expectation of return in case of a disaster. Typically a more expensive policy will give you greater returns. However, you need to make sure this is specific to your circumstances. If you're provided with a whole bunch of benefits that you don't really need it's a waste of money. If you don't have enough coverage and you, unfortunately, need to access a lot of services it can be a big problem. As we know none of us can predict the future, however, you need to put lots of thought into what is the most likely injury or illness that could happen to you and your family and find the policy that gives you the best coverage for those outcomes.

What happens if I'm born overseas? or overseas resident?

In Australia, if you're born overseas you're still able to access health insurance including physiotherapy. Companies have dedicated policies for people born overseas or non-Australian residents. Unfortunately, these policies can be a little bit more expensive. If you're an Australian resident you're typically eligible for Medicare. I understand that if you're an overseas resident you might not have the same eligibility and hence your health insurance policy will be more expensive because it needs wider coverage.


I hope this blog has provided you with some useful information about how health insurance and physiotherapy work. If you need any extra information don't hesitate to contact me. Owner Health is a home visit physiotherapy service and we operate Australia wide. If you need physiotherapy and have health insurance we are happy to help.

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