Private Health Insurance and Physiotherapy

The Enhanced Primary Care (EPC) program is a Medicare initiative aimed at supporting patients with chronic medical conditions and complex care needs. Under this program, patients can access allied health services, including physiotherapy, to better manage and improve their health. 

The EPC program specifically targets individuals with chronic or complex health conditions that require ongoing care. Patients must be assessed and referred by their general practitioner (GP) to access allied health services under the EPC scheme.

To access physiotherapy services under the EPC program, patients need a referral from their GP. The GP assesses the patient's condition, determines eligibility for EPC, and develops a care plan.

With an EPC plan in place, patients can access a certain number of subsidized sessions with allied health professionals, including physiotherapists. These sessions are designed to address the patient's specific health needs and contribute to their overall well-being. Book an appointment Now

Medicare provides rebates for a set number of allied health sessions per calendar year under the EPC program (it covers up to five (5) treatment sessions per calendar year, i.e. five sessions between Jan 1st – Dec 31st each year). Patients can claim these rebates, reducing the out-of-pocket expenses associated with receiving allied health services. As of July 2023, the prevailing Medicare reimbursement is $58.30 per consultation, irrespective of the allied health service recommended by your GP. This reimbursement of $58.30 applies to both the initial consultation and any subsequent review sessions that may be advised, up to a maximum of 5 sessions. Unfortunately, our clinic cannot utilize bulk billing with Medicare, meaning there will consistently be a gap payment required to cover the remaining portion of the fee. Call us to know more about this.

Work-Related Injury:

To be eligible for WorkCover, your injury must be work-related. This includes injuries sustained at your workplace or during work-related activities.

Notification and Reporting:

It is crucial to report the injury to your employer promptly. Your employer will guide you through the process of notifying WorkCover and commencing a claim.

Accepted WorkCover Claim:

Your WorkCover claim must be accepted before you can access physiotherapy services. This typically involves an assessment by WorkCover to determine the validity of your claim. Book an appointment Now

Physiotherapy Prescriptions:

WorkCover may prescribe physiotherapy as part of your rehabilitation plan if deemed necessary for your recovery. Book Now

Treatment Approval:

Physiotherapy treatments recommended by your healthcare provider, including the number of sessions, will be subject to approval by WorkCover.

Coverage Duration:

WorkCover often covers a specific number of physiotherapy sessions within a defined timeframe. The duration and extent of coverage depend on the nature and severity of your injury.

Reassessment and Continued Support:

WorkCover may reassess your progress periodically, and additional physiotherapy sessions may be approved if required for ongoing rehabilitation.