Australia’s Medicare system provides quality medical care for millions of people around the country. You’ve probably visited a bulk billing GP and have not had to pay any out-of-pocket expenses because Medicare fully covered your consultation.
Unfortunately, this isn’t as straightforward for allied health providers. So if you’re looking for a bulk bill chiropractor near the Brisbane CBD or the Brisbane Northside suburbs, this article may help you understand how the Medicare system works for allied health providers.
What is Bulk Billing?
Bulk billing is when your doctor submits the bills directly to Medicare as payment for the services provided to you. There are a number of medical practices that offer 100% bulk billing. This means that there is no out of pocket payment for you as the patient as Medicare will pay your full consultation fee.
For allied health providers such as chiropractors, physiotherapists, osteopaths etc. Medicare will only give you up to 5 sessions per year, provided that you have another pre-existing health condition as determined by your GP.
What is Mixed Billing?
Mixed billing is when practices charge you a gap payment, which is the difference between the Medicare rebate and the consultation fee charged by the practice.
This is becoming increasingly more common in medical practices because the rebates paid by medicare just haven’t kept up with the increasing cost of running a practice. It is up to you to check with the practice before scheduling your appointment as to whether they offer 100% bulk billing or not.
Does our practice offer 100% bulk billing for chiro appointments?
Unfortunately not, our practice is a mixed billing practice. That means that the Medicare rebate does not cover the full cost of the consultation and you will be responsible for a gap payment.
The Medicare rebate is currently $55.10 (July 2022), meaning that the gap payments for your first session will be $64.90, and the gap payment for any follow-up sessions will be $34.90.
In order to access this rebate from Medicare, you will require a Chronic Disease Management (CDM) referral from your GP. This is explained further in the FAQ’s below.
We have chosen to operate as a mixed billing practice because we are not willing to compromise on the service that we offer you. Our initial session is around 45 minutes and follow-up sessions are 30 minutes. We schedule longer appointment times so that we can treat the joints, surrounding soft tissues such as muscles, tendons and ligaments and recommend preventative rehabilitation exercises. We simply cannot do all this in 10-15 minutes.
Your GP will need these details from us.
In order to benefit from the medicare rebate for your chiropractic session your GP will need to put our practice details on your referral form.
Provider name: Dr Michael Benporath (Chiropractor)
Provider Number: 5677425L (Newmarket) or 5677427K (Cleveland)
Practice Name: Prime Health Co.
Fax Number: (07) 2111 8676
Bulk bill chiropractor FAQ’s
Can a chiropractor bulk bill in Australia?
Yes they can bulk bill provided that you have one of the following; a Chronic Disease Management or CDM (formally an Enhanced Primary Care or EPC) referral. A Department of Veteran Affairs gold or white card. Or a WorkCover case number.
This is at the discretion of the practice as to whether they offer 100% bulk billing or mixed billing. It’s advisable to check with the practice before scheduling an appointment.
You will need the appropriate referral from your GP to access the Department of Veteran Affairs, Chronic Disease Management or WorkCover benefits. With the appropriate referral from your doctor, your chiropractor will be able to bulk bill the relevant department directly. You may or may not be responsible for a gap payment, which is the difference between the Medicare approved rebate rate and the fee charged by the chiropractor’s practice.
What is the Chronic Disease Management (CDM) plan?
The CDM plan is for patients with a chronic medical condition who require a structured treatment approach from a multidisciplinary team. For example, their GP and two other health or allied health care providers. This is the referral that you need to see an allied health provider and receive a rebate from Medicare.
How many chiropractic visits do you get on Medicare?
Your GP can prescribe you a maximum of five visits per year with a chiropractor or other allied health provider. Unfortunately this is the limit and cannot be increased.
How do I get chiropractic treatment on the Medicare CDM plan?
Your eligibility for treatment on a CDM plan is assessed by your GP. If you have been suffering with a chronic condition, one that has lasted longer than 6 months duration or have other health issues, then you may be eligible. Although there isn’t a complete list of eligible conditions, some common conditions include musculoskeletal conditions, heart disease, diabetes, asthma, depression, anxiety, emphysema and many more.
Can a chiropractor help get me onto a CDM plan?
Yes certainly we can help. If you have already seen us for an assessment then we can contact your GP, explain our findings and what treatment protocols we recommend. This allows the GP to get a better understanding of what the chiropractor can do for the patient. Overall this leads to better outcomes for the patient when there is good communication between the GP and the chiropractor.
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