Chiropractic treatment under Medicare, DVA, ICWA, and WorkCover.
At Fortitude Chiropractic located in Perth, Western Australia, we generally see about 80-85% of our patients as private clients. This means that most patients will come without a referral and they will be paying out of pocket for their treatment or in many cases claiming a portion of their consultation fee through their private health insurance and receiving an on-the-spot rebate for this using our HICAPS terminal.
However, we are finding that a growing number of patients are receiving chiropractic treatment under third parties and government schemes. This includes the following:
– Medicare care plans / GP Chronic Condition Management Plans – also known care plans, EPC, CDM or GPCCMP
– Department of Veteran Affairs (DVA) for White and Gold Card holders
– The Insurance Commission of Western Australia (ICWA) or Motor Vehicle Accident Insurance
– WorkCover WA or Workers Compensation Insurance
The purpose of this article is to provide information to current patients and potential new patients, to help clarify how the process works, when you need a GP referral and what the requirements are if you are receiving treatment under any of these third-party or government programmes.
Medicare Care Plans (CPCCMP/CDM/EPC’s)
This is probably the most common third party program that we see patients through. The Medicare care plan scheme is a Medicare scheme whereby a patient’s GP can refer them for allied health management such as chiro, physio, podiatry, dietetics or other under a Medicare scheme. This allows patients to access a medicare rebate or funding towards up to five total combined allied health visits per calendar year. At Fortitude Chiropractic, we accept medicare care plans and GPCCMP’s.
If you are to receive treatment under a care plan, here is what you require:
– GP referral letter including care plan letter with full documentation. Most GPs understand this process and if you have a suitable medical condition, such as ongoing chronic pain or injury for more than six months, you may be eligible for this referral.
– You must be a Medicare card holder and must provide all your Medicare card details and information to us.
– You also mustn’t have already exceeded the total number of treatments. Despite whatever date of the referral is and which year, Medicare will only rebate five sessions per calendar year total. This doesn’t mean five chiro and five physio sessions. This means this is a total of five between all allied health sessions. If you’ve already used your allocation, even if you have another referral from your doctor, we will not be able to process any Medicare claims.
Department of Veterans’ Affairs (DVA)
DVA exists to support Australia’s veterans in receiving medical treatment and other help, which is required due to any injury or medical conditions obtained during their service. We proudly bulk bill all our veterans who hold either a white card or a gold card and are covered under DVA.
Here’s what you’ll need before seeing us under DVA:
– Referral letter from your doctor, complete with documentation. DVA stipulates very clearly that for patients to receive any treatment funded through DVA, they must have a correct referral letter from their doctor. Re-referral is required every 12 visits or once every 12 months, whichever occurs sooner.
– You must have an active white or gold card. Gold card means you are covered for all treatment. White card means you have approved conditions related to military service. For example, you might be covered under a white card for chronic lower back pain or recurrent ankle sprain.
– You need to bring your GP referral as well as all DVA card details to your appointment.
Insurance Commission of WA (ICWA) or motor vehicle accident insurance
Treatment under ICWA is a little bit more complicated than the above two. Essentially, the ICWA provides compulsory third party insurance for all drivers in Western Australia. A portion of the registration you pay on your vehicle covers this compulsory third party and it means that if someone is injured on the road due someone else driving (the injured driver is not at fauly), then this insurance will activate. This will generally cover the reasonable costs of treatment of medical expenses and injuries.
You won’t automatically be covered by ICWA just because you’re injured in a car accident. What is required here is that you need to contact the Insurance Commission of Western Australia, either online or over the phone. You will lodge a case or claim. From here, Insurance Commission will review and then hopefully approve your claim. You will be issued with a claim number as well as a HICAPS treatment number and generally they’ll email or send you a text to confirm that you are covered for treatment under ICWA.
From here, you’ll be able to see a chiropractor or other allied health professional, so long as they accept ICWA. In order to claim treatment at a clinic under ICWA, you will need to bring your claim number, your HICAPS number and any documentation from ICWA which stipulates that they have approved your claim. This is very important as if we aren’t able to verify that your claim has been approved, you will have to pay for treatment out of pocket in hope to be reimbursed later.
Despite popular opinion, ICWA has confirmed recently with the Australian Chiropractors Association that patients actually don’t need a GP referral to seek initial treatment under ICWA. ICWA can request a GP referral for treatment later on if you have completed a certain number of sessions and are seeking further visits, but it is not an initial requirement. However, if you have a GP referral or any other scans, documentation, hospital discharge letter relative to your injury, please bring this along to your appointment so that we are fully prepared and have all the information to provide you with the best possible care.
Once you have been seen for your first visit under ICWA, your Chiropractor will liase with them on your behalf and seek appropriate approval for ongoing treatment.
WorkCover WA or workers compensation
Unfortunately, the WorkCover system is probably the most complicated and confusing when it comes to receiving chiropractic treatment. How to see a Chiropractor in Perth under workers compensation is a common query we receive. There’s quite a few different parties involved in WorkCover and we need to get all of them on board in order for you to be able to receive Chiro treatment, funded by workers compensation and the relevant insurance company
Initially, you must have an active WorkCover or workers compensation claim. This occurs from initially visiting your GP and being given an initial WorkCover certificate of cover. Your GP is the controller or the gatekeeper of the WorkCover process.
The next thing that you require in order to have chiro treatment under WorkCover, is a GP referral. This must state specifically that they are referring you to a chiropractor.
As well as this, before we can invoice under WorkCover directly for treatment, what we need is to get approval from the insurer which your work uses to cover you under workers compensation or WorkCover treatment. Insurers vary in terms of their approach to approving treatment.
Often times, the insurance company will require what we call a ‘treatment and management plan’ from the treating practitioner such as a chiropractor in order to propose what your problem is, diagnosis and the treatment rationale and what the treatment recommendations include.
In this case is you may need to come in for your initial appointment and cover the cost of treatment out of pocket for your chiropractor to then provide this treatment and management plan and send it to your insurance company. Then they can approve the treatment under WorkCover and then we’ll be able to bill your sessions directly to your insurer going forwards.
STILL NEED CLARIFICATION – WE’RE HERE TO HELP!
We hope that this clarifies the process of you receiving treatment under the above schemes.
We try and be as transparent, clear, and as informative as possible to help patients navigate these often confusing treatment and referral systems. If you’re looking for an initial appointment, or you’re a current patient of ours looking to receive treatment under one of these plans, but you’re still confused on any clarification, please get in contact with us at the clinic.
Email through your inquiry and the team will get back to you soon.
If you’re ready to go and understand things and want to book in, you can book online here for your initial consultation.