The Blys Guide to Health Fund Rebates for Massage Therapists in Australia

This topic
seems to have so many massage therapists stumped. We get a lot of questions around health funds, and we get it.
It’s tricky!

There are around 40 health fund providers. They each set their own criteria for what
a therapist must have in order to qualify to get a provider number through them, and they can change that
criteria at any moment. They only communicate with the associations, not the schools. So, then the schools have
to keep in touch with each association to try to stay on top of the new requirements being set by each of the 40
health fund providers.

It’s not easy to understand, which is why we’ve created our step-by-step guide to how
to get set up with health funds as a massage therapist.

Let’s start with the basics:

What are Health Funds?

“Health fund” is simply another way to say health insurance provider. These insurance
providers sell hospital coverage plans to clients that can include extras. Under the extras, specific services
such as Therapeutic or Remedial Massage can be subject to a discount or rebate given by your health fund. Often,
people will refer to the discount that is given for a specific service as a health fund rebate. This rebate will
be a certain amount per appointment up to a yearly limit, depending on which plan the client has. Once a client
reaches that limit, they can no longer receive that rebate for that type of service until the next year.

In order for the client to get the rebate, the therapist providing the massage must
have a valid provider number for the health fund that the client has.

How does a massage therapist get a health fund provider number?

In order to be eligible to get most health fund provider numbers the massage
therapist must have a Diploma of Remedial Massage. Latrobe Health Services and CBHS are the only health
insurance companies that allow therapists who have only a Cert IV in Massage Therapy to get a provider number
for “therapeutic massage”.

After you’ve gotten your massage qualification, the next step is to belong to an
association. You apply for your provider numbers through your association. Each association should have a lot of
information to help you get this done.

According to MAA, these are the most common requirements by Australian health
insurance funds:

1. Membership to a recognized Association
2. Current professional indemnity insurance
3. Current Level 2 First Aid certificate
4. Massage therapy qualifications at either the
   Certificate IV, Diploma or Bachelor degree level gained from an Australian Registered Training Organisation
   (RTO)
5. A commitment to a certain number of Continuing
   Professional Education (CPE) points annually (depending on your association requirements)

Each health fund will have their own requirements for therapists to be listed as
providers. In our Health Fund Rebates Guide, we’ve provided the requirements of a few of the health insurance providers.

Once you belong to an association, you will need to send in your required documents
that they will need for your provider numbers.

• professional indemnity insurance  
• current HLT first aid  
• practice address details

Some of the health funds will use your association numbers, but others you will need
to apply to the health fund directly. You can find information on which are which in our Health Fund Rebates Guide below.

After you’ve applied, all that’s left is to wait for your provider numbers to come
in. Each association has a specified reporting cycle (date each month that they send off for new applicant’s
provider numbers) for each different health fund. Check with your association to see which dates they process
which health fund applications.

According to AMT, in order to maintain your health fund numbers you must:

• retain a copy of your provider numbers. Your
  association cannot do this on your behalf.
• contact the health fund directly for your provider
  number
• contact the health fund directly when your client has
  difficulty with a claim.
• inform your association promptly of any changes to
  your details, such as new practice or mailing addresses  
• submit current copies of your first aid, insurance
  certificate of currency, CEU documentation and renewal fees before the due dates.
• abide by the various health fund Terms and
  Conditions.
• maintain appropriate treatment records.

What should you do if you treat clients while still waiting to receive your provider number?

You may still issue a receipt for treatments, but instruct clients to hold off making
a claim for at least a month. Inform your clients that your application for a provider number is currently being
processed and may take up to six weeks to come through. This gives the funds time to process and prevents a
potentially embarrassing scenario where a client’s claim is rejected.

What needs to be on the receipt provided to the client?

The following details must be clearly printed on receipts, invoices and tax invoices
(it cannot be handwritten):

• Name of the therapist who gave the treatment
• Business name (if applicable )
• Practice address. This must be a street address not a
  PO Box.
• Contact number
• Association and member number
• ABN  

The following details must also be included but may be handwritten:

• Client’s name and address
• Date of treatment
• Nature of treatment
• Health Fund provider number
• Amount Paid for Massage
• Date of payment

You must give an accurate description of the treatment performed on your receipts
(e.g. Remedial Massage, Chinese Medicine Remedial Massage, Myotherapy etc). Issuing a receipt for services that
did not take place is a form of fraud.

What types of massage are covered by health funds?

Each of the health funds may cover a few different types of massage. For the sake of
our chart we were focusing on mobile Therapeutic (Swedish/Relaxation) and Remedial massage. We called each one
of the health fund providers on our chart, and as you can see nearly all of them do cover Remedial in-home
massage, and only two of them will cover Therapeutic in-home massage.

There are very specific requirements of a Remedial treatment that must be covered in
order for the treatment to be eligible for the health fund rebate.  Remedial Massage is defined by ATMS
as:

“Remedial massage is the systematic assessment and treatment of the muscles,
tendons, ligaments and connective tissues of the body to assist in rehabilitation, pain and injury
management. It’s performed to create favourable conditions for the body to return to normal health after
injury and is defined by the premise that the treatment can reasonably reverse certain physical effects a
patient may be presenting.”

Before any remedial massage treatment begins, a thorough patient consultation and
assessment is to be performed to ascertain the patient’s current health status. If the patient is suitable for
remedial massage and relying on the patient’s feedback to identify the areas that require attention, the
therapist can then apply the relevant and appropriate treatment.

The assessment must include the development of a specific treatment plan as to the
best course of treatment for the patient’s condition/injury. This treatment plan forms the basis of the clinical
notes. These notes must be consistent with the your association Code of Conduct, the Unregistered Health
Practitioner Act, and the additional requirements set by the individual health funds.

Final notes

We hope this has been an informative guide on the basics of health funds and how they
work. Check out our Health Fund Rebates Guide below to get information
about specific health funds, what they require, what they cover, and more.

It is important to note that different massage associations have interpreted the
various private health fund provider recognition criteria in different ways. For the most up to date information
about a particular health fund, it is best to check directly with the specific health fund provider or your
massage association.

Health Fund Rebates Guide