Dr Alison Vickers tries to unravel some of the situations when Medicare will cover some of the cost of a visit to a psychologist, speech pathologist, occupational therapist or other allied health provider.
Most people know that when they see a GP or specialist that Medicare covers all or at least some of the cost of their consultation.
What is more confusing for patients and GPs is when Medicare will pay for visits to an allied health provider. There are two different schemes. Both of which apply to adults and children.
The first and simplest is called Better Access. If a patient has a diagnosable mental health problem like anxiety or depression then their GP, paediatrician or psychiatrist can develop a GP mental health plan. As part of this plan patients can then be referred to a psychologist and some occupational therapists and social workers. Medicare then covers most of the cost for up to 10 visits in a calendar year. There is often a gap averaging $60/ visit that the patient pays above the Medicare rebate.
The second scheme is more complicated and based on the idea that if a patient has a complex chronic health problem then they are eligible for a total of five visits in each calendar year to allied health providers (included in the coloured box) to manage their chronic condition. The GP is the only person that can make the referral. The GP needs to decide that the patient has a complex chronic medical condition which has been present or is likely to be present for at least six months and requires the care of at least two other health providers (one can be a specialist). The GP can then write a plan called a management plan which they need to discuss with or send the other health providers called a team care arrangement. With all this in place the GP completes a special referral called an EPC referral. This referral means the patient can claim $52.95 for each of the five visits.
Allied health providers covered by Medicare:
- Aboriginal Health Worker
- Audiologist
- Chiropractor
- Diabetes Educator
- Dietitian
- Exercise Physiologist
- Mental Health Worker
- Occupational Therapist
- Osteopath
- Physiotherapist
- Podiatrist
- Psychologist
- Speech pathologist