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  • Writer's pictureKathy Ozakovic

Medicare & Private Health Rebates - Everything You Need To Know

I like to have a Discovery Call with my first time clients so that they can meet me and feel more comfortable during their Initial Consultation, and so that I can assess whether they are eligible for Medicare rebates. I highly encourage clients use their benefits. Even if they have Private Health insurance I will always recommend they obtain an EPC as well, if eligible. So, what is an EPC and makes you eligible for it? Read more.


PRIVATE HEALTH

Private Health is pretty straight forward. Call up your Private Health Insurer and ask whether dietetics consultations are covered. Some private health insurers will not cover Nutrition consultation but will cover dietetics. Dietetics is a clinical science, think hospitals. Dietitians are kind of like doctors for food.


If you Private Health Insurer covers dietetics consultations, great! All you need to do to claim your rebate is provide them with the PAID invoice record which NuFit Wellness provides you with upon payment. This can be done lodging online, via email or via phone. It is a process you take responsibility of.



CHRONIC DISEASE MANAGEMENT PLAN - Formally and better known as ENHANCED PRIMARY CARE PLANS (EPC)

These are little bit more tricky to come by and NuFit Wellness takes responsibility of processing your claims for you. Once you obtain the referral, the paperwork should be emailed to hello@nufitwellness.com.au so that claims can be processed. Your Rebate of $55.10 or $56.00 will be deposited directly into you bank account as updated on your online Medicare account (linked to your mygov).


If eligible, you are entitled to a total of 5 rebated sessions over 12 months. The really sucky thing is that dietetics is not the only allied health service under this scheme. It also includes physios, chiropractors, podiatrists, diabetes educators, mental health worker, osteopath, speech pathologist, audiologist. Would be cool if you got 5 PER SERVICE but no, the 5 sessions are to be divided amongst a total of 13 allied health professionals listed. So, you gotta pick and choose who you wanna see and the GP will be the judge of that. After 12 months you can go get another EPC plan and 5 rebates sessions.


The reason they are a little bit more tricky to come by is because there is certain criteria to meet. Essentially, it makes the GP work a little bit extra! If you've got an integrative GP they are more likely to help you out. Some doctors don't understand the criteria well and are fearful of Medicare audits when they don't need to be.


The Criteria:

  1. Having a chronic condition; and

  2. Complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a shared care plan or under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person's medical practitioner has contributed to a multidisciplinary care plan;

A chronic condition as defined by Medicare is one that has been (or is likely to be) present for six months or longer, for example, asthma, cancer, cardiovascular disease, diabetes, musculoskeletal conditions, stroke. There is no list of eligible conditions; however, the CDM items are designed for patients who require a structured approach, including those requiring ongoing care from a multidisciplinary team. Whether a patient is eligible for CDM services is a clinical judgement for the GP, taking into account the patient’s medical condition and care needs, as well as the general guidance set out in the MBS. I pulled this out directly from the Department of Aged Care and Health referenced below! Would really like some GPs to read that.

So, what's the process of getting an EPC referral for a dietitian? Here is what I recommend for your best chance of getting your benefits:

1) Visit your GP and do a routine blood test. Make sure she/he includes to check: FBC, BGL, Cholesterol, B12, vitamin D, Iron studies, Thyroid. This is to cover all basis and have a baseline of bloods so we can measure progress. If you GP wants a reason, give him one! How have you been feeling lately and what changes have occurred in your life? Fatigue? Low mood? Bowel habits changed? Gained weight? Lost Weight? Increased stress?

2) Ask if you can have an EPC referral to see a dietitian on the basis of your nutritional symptoms of ... (we discuss this in your Discovery Call) - some GPs may find this enough others may want to wait to see your blood test results.


3) YOUR GP WILL ASK FOR THESE DETAILS - available in the footnote of my website

  • APD Kathy Ozakovic

  • Provider Number 5544143W

  • APD number 182106

  • Business Address: 11/22 Phillips Road Kogarah NSW 2217

  • Contact number: 0448 840 632

4) Make sure your blood test rests are sent to kathy@nufitwellness.com.au (myself)


5) BOOK IN YOUR INITIAL CONSULTATION: BOOK HERE

You can book your appointment 2-3 weeks in advance as this could be enough time for you to obtain the referral and blood test results (depending on your personal circumstances, workload and GP availability)



Eating Disorder Services (ED)

This is fairly new. This didn't exist when I was going through my ED. In fact, I was never formally diagnosed so one could say I never had an Eating Disorder. We all know that would be a lie as I recall eating one egg a day and feeding my Golden retriever my school sandwiches. Not to mention the obsessive calorie counting and food diaries I kept (read my story here, listen about my journey here) and although this was 10 years ago now, I remember how my younger self felt at the time and it has provided me with an immense level of empathy and compassion for my clients.


THE GOOD NEWS: Clients formally diagnosed with an Eating Disorder by a GP are entitled to up to TWENTY (20 x $56.00) rebates sessions to a dietitian! As well as additional 10 psychology rebated sessions!


A client can HAVE ALL 3 of the below!

EPC (5 allied health rebates, including dietitian) AND

Mental Health Plan (10 + 10 psychology rebates thanks to COVID we now have 20 total) AND

Eating Disorder Support Plan (20 dietetics + 10 psychologist)


This makes me happy. It is so needed. I wish I had the right support back then and I am so grateful because my struggle is my gift.



REFERENCES




Did you find this blog helpful and informative? Tag & Share with your friends who would love it too! Sign up for my Free NuFit Wellness Newsletter to stay in the loop. Attend my Wellness Workshops. I help clients Achieve & Maintain Wellness through Nutrition for Gut Health so that they can thrive in life. Wellness Dietitian & Holistic Nutritionist, Health Coach, Health Presenter, Gut Health Specialist - Kathy Ozakovic.

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