Information about available rebates
Certain Private Health Insurance and Medicare funding is available for services provided by our Speech-Language Pathologists:
Private Health Funds
Speech Pathology services can be rebated under certain ancillary tables of private health funds. Consult your health fund to obtain details on the rebate amount for speech pathology consultations and the maximum amount you can claim per person or family in a calendar year.
Client claims can be automatically processed by Gameplan's electronic HICAPS terminal if your health fund is registered. Once your claim is authorised, you simply pay the gap amount - the difference between the full fee and the amount claimed from your health fund.
Medicare Items for Chronic Disease Management (CDM)
- Eligible clients can claim up to five speech pathology sessions per calendar year.
- Client claims are processed by Gameplan's electronic 'Medicare Easyclaim' terminal and are paid into the client's bank almost immediately.
- Formerly known as the Enhanced Primary Care (EPC) Program.
Who is eligible?
Clients who have a chronic medical condition and complex care needs that are being managed by their GP may be eligible. A chronic condition is one that has been present for six months or longer. Clients have complex care needs if they need ongoing care from a multidisciplinary team consisting of their GP and at least two other health care providers, one of which may be a speech pathologist.
If you are unsure as to your child’s (or your) eligibility please discuss this with your GP.
Who makes the referral to a speech pathologist?
The GP will prepare a GP Management Plan and Team Care Arrangements and make the referral to the speech pathologist using a referral form. The client cannot claim the rebate from Medicare until the speech pathologist receives the referral form. The client may request to see a Medicare registered speech pathologist or the GP may recommend one.
Gameplan's speech pathologists are registered with Medicare.
What does the client receive?
The GP nominates the number of sessions up to a maximum of 5 per calendar year. The five sessions are per client, not five sessions per allied health professional, and may be with a number of allied health professionals (e.g., three with a speech pathologist and two with an occupational therapist).
If all sessions are not used during the calendar year in which the client was referred, the unused sessions can be used in the next calendar year. However, those sessions will be counted as part of the five sessions with allied health professionals available to the client during that calendar year.
Clients continue to be eligible for rebates for speech pathology while they are being managed under a GP Management Plan as long as the need for eligible services continues to be recommended, by their GP, in their plan.
What is a session?
A session is a consultation with an allied health professional. The consultation must be of at least 20 minutes duration and must be provided to an individual client. The speech pathologist named on the referral form should provide the service. If there is a change in the speech pathologist providing the service the GP should be notified of the change.
How much is the rebate?
The rebate is currently $52.95. Medicare rebates are indexed on 1 November each year (next index November 2015).
Please note: in most cases the Gameplan session fee will be more than the rebate. The out-of-pocket expense will count towards the Medicare safety net.
Claiming a rebate
Upon payment of the fee Gameplan will provide the client with a receipt. The receipt will include:
- Client’s name
- Date of service
- MBS item number (Speech Pathology item number = 10970)
- Speech pathologist’s name and provider number
- Referring GP’s name and provider number
- Date of referral
- Amount charged
- Total amount paid
- Any amount outstanding in relation to the service
Client claims are then processed by Gameplan's electronic 'Medicare Easyclaim' terminal and are paid into the client's bank almost immediately.
If the client loses track of how may speech pathology services they have claimed in a calendar year they can contact Medicare on 132 011.
What happens if the client has private health insurance?
The client may not claim a Medicare rebate and a private health insurance rebate for the same service. The client must choose which rebate they are going to claim for a service.