Private Health Insurance for Physiotherapy

Published: November 1, 2019

If you need to visit a physiographist regularly, for example, for back pain, carpal tunnel syndrome, or arthritis, a private health insurance policy might help you reduce out-of-pocket costs.

Health funds in Australia provide you with cashback when claiming physiotherapy benefits through their Extras cover. Extras health insurance provides benefits toward the cost of general treatment received outside of the hospital to help you prevent or manage injuries and illnesses.

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Who benefits from physiotherapy?

Physiotherapy increases the quality of your life by using techniques, such as manual therapies and exercise, to help improve movement and reduce pain and stiffness. Typically, physio is helpful to people with chronic diseases, older Australians, athletes, and children with challenges such as balance and coordination. Benefits generally include:

  • Recovery from injury or trauma,
  • Reduce or eliminate pain and stiffness,
  • Helping you avoid surgery,
  • Improve muscle strength and range of motion,
  • Help manage many age-related health problems, like joint pain, osteoporosis and arthritis,
  • Recovery from stroke or paralysis,
  • Improves endurance for athletes and recovery from sports injuries,
  • Recovery for cardiac and lung rehabilitation after a heart attack.

Is physiotherapy covered by health insurance?

Yes, it’s possible to get coverage for physiotherapy treatment when purchasing an eligible Extras policy from a private health insurance company. There is generally a limit on how much physiotherapy you can claim. Your annual benefit limit depends on the health fund and level of cover you choose.

What physio services are covered by health insurance?

The cover and claim amount provided by your physiotherapy benefit will depend on your specific condition, health fund and the level of cover you choose. Usually, you'll have the option of Basic, Mid or Top Extras policy. The following services might be covered:

  • Initial consultation and diagnosis,
  • Follow-up consultations,
  • Development of your treatment plan,
  • Rehabilitation,
  • Medically necessary dry needling,
  • Electrotherapy if medically necessary,
  • Medically necessary Pilates and hydrotherapy,
  • Gym membership if medically necessary,
  • Antenatal exercise classes, and
  • Compression recovery items.

Compare the best private health cover for physio

Health Insurer Annual benefit limit Maximum benefit

Super Extras
$600 per policy. $44 for initial visit
$34 for subsequent visit

Advanced 80%
$600 per policy. 80% for initial visit
80% for subsequent visit

Top Extras 75
$800 per policy. $41.10 for initial visit
$33.30 for subsequent visit

Top Extras 75%
$500 per policy combined with exercise physiology and other services. Sub-limits apply. 75% for initial visit
75% for subsequent visit

Top Extras
$600 per policy combined with other services. $60 for initial visit
$54 for subsequent visit

Premium Options
$200 per policy combined with eye therapy, occupational therapy and speech therapy. Sub-limits apply. $45 for initial visit
$40 for subsequent visit

Top Extras
$600 per policy combined with other services. 75% for initial visit
75% for subsequent visit

High Extras
$500 per policy combined with exercise physiology, eye therapy, occupational therapy and other services. Sub-limits apply. $51 for initial visit
$41 for subsequent visit
Source: privatehealth.gov.au (29 October 2019).

Take note: This is not a comprehensive list of health funds that cover physiotherapy, but rather a breakdown of the health insurance companies we compare. The above information is based on a single adult living in Queensland applying for Top Extras cover on the 29 October 2019.

Find the best private health cover for physio

Possible limits on your physio Extras cover

The benefit amount you can claim will typically be either a percentage of the benefits, for example, 75% back on physio treatments, or a set benefit, for example, $45 back from initial physio consultations.

Carefully review the limits attached to your Extras policy. Your benefit limits will depend on your insurer and the level of coverage you choose. You can generally expect increased limits with higher Extras policies.

  • Annual limits: The maximum benefit amount you can claim within a particular 12-month period.
  • Combined limits: When several services are combined under one limit. For example, $600 for physiotherapy and occupational therapy. If you use $600 on physio, then you won't have any benefits left for occupational therapy.
  • Sub-limits: The maximum benefit payable, within a 12 months period, for a specific service, this is a deduction from a larger limit. For example, if you have a combined limit of $600 for physiotherapy and occupational therapy, with a sub-limit of $300 for each service, then the max amount you can claim for physio a year is $300, with the remaining $300 allocated to occupational therapy.

Does Medicare cover physiotherapy?

Yes, Medicare generally provides a rebate for physiotherapy health services for up to 5 'Allied Health' consultations per calendar year if you qualify for the Chronic Disease Management (CDM) program. The CDM program is generally available to people with chronic or complex medical problems. The 5 visits restart each calendar year, but every 12 months you’ll need a new referral from your GP.

Medicare rebate qualifying conditions generally include:

  • Having a Chronic Medical condition (CMC) that’s been diagnosed by your GP and been present for 6 months or longer and
  • Being referred to an eligible physiotherapist by your medical practitioner, and
  • Your medical practitioner must complete all the relevant paperwork, including a referral form issued by the Department, GP Management Plan (GPMP) and Team Care Arrangements (TCA).

Important: If you have private health insurance, you should preferably use your Medicare entitlements first, and then use your insurance rebates for any outstanding amounts.

How much does Medicare pay for physiotherapy?

Medicare generally pays 85% of the physio fee, which amounts to $53.80 per treatment for a physio consultation (October 2019).

To claim your Medicare rebate, you generally pay the full consultation fee at the time of your appointment. Your physiotherapist will then process the payment that links into Medicare, and your rebate will then be paid directly into your bank account within 1 to 3 working days. Alternatively, you might be able to claim on the spot by swiping your Medicare card on their HICAPS machine, and the rebate will be paid back into your Debit Card.

If neither of the above claiming options are available, you’ll generally need to go to the Medicare office and have them reimburse you.

Can you bulk bill physiotherapy?

Whether your physiotherapist bulk bill is entirely dependent on them. So, you might want to ask the medical practitioner conducting your referral who their preferred physio providers are and whether they bulk bill.

Frequently asked questions and answers

How much does physiotherapy cost in Australia?

Depending on where you live and the physiotherapist you’re referred to, an initial consultation of about 45 min can cost between $110 and $145. Follow-up consultations are generally between $80 and $95.

How long is the waiting period to access physiotherapy benefits?

Generally, you’ll have to serve a 2-month waiting period after commencement of your policy before you can claim benefit.

Can you get health cover for physio without serving a waiting period?

Typically, waiting periods apply to all health funds. However, the amount of time you’ll have to wait for physio depends on the health fund and level of coverage you purchase.

How do you claim physio benefits?

Depending on your chosen provider, you can generally claim physiotherapy sessions on the spot by swiping your insurance card at their HICAPS machine. Alternatively, your insurer might have a membership portal on their website, where you can submit claims online.

You can also complete and post the relevant claim forms, which you can generally download from your health fund’s website, along with copies of your physio receipts. Otherwise, you can always lodge your claim with Medicare, who will then forward the outstanding amounts to your health fund.

Reduce physiotherapy cost with private health insurance

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