Looking to get cover for podiatric treatment? Compare cover from leading funds.
A sore foot or ankle can be a painful experience. Often it’s the cost associated with funding treatments and surgical procedures, and the time taken to heal that leaves many walking backwards when thinking about seeing a specialist.
A Podiatric surgeon is qualified to care for bone, joint, ligament, muscle and tendon pathology of the foot and ankle. This article will explore how podiatric surgery is covered by private health insurance.
How much is private podiatry insurance?
Below you will find a selection of policies from Finder partners that include podiatry. They all have a 2 month waiting period, and different conditions for orthotics. Prices are based on a single person with $500 excess living in Sydney, NSW.
| Provider | Tier | Price per month | Apply |
|---|---|---|---|
 Starter Silver |
Silver | $105.65 | Go to Site |
 Hospital Silver |
Silver | $109.55 | Go to Site |
|
Silver Advantage Hospital Plus |
Silver | $147.04 | Go to site |
What podiatric service costs will my health fund cover?
If podiatry services are included on your hospital policy, your health funds is required by law to pay the minimum default benefit for your treatment. If your surgery goes over this cost, you’ll have to pay the difference.
What does the default benefit cover?
The default benefit covers the accommodation cost of you being treated as a private patient in a public hospital. This treatment is done in a shared room, but only covers a portion of the accommodation, and none of your theatre fees in a private hospital. If you choose a private room, you could be whacked with an added out-of-pocket expense.
Your health fund doesn’t have to pay benefits for the cost of podiatric services unless it’s included under your policy as there is no Medicare item number. This means Medicare won’t pay any benefits toward the cost for a surgeon or anaesthetist’s fees.
Certain health funds may consider paying benefits for medical costs from their own hospital policy, but this is up to your fund. Your fund may also cover the cost of a prosthesis, but your podiatrist must be listed on the Government approved Prostheses list for this to happen.
It’s important to note that if your podiatrist isn’t accredited with the government, your health fund will only be able to pay a benefit under General Treatment (Extras) cover, and no Hospital Cover benefit will apply.
Where is podiatry treatment performed and how is it covered?
Podiatric surgery is performed in private practice, community health centres, day
surgery centres and some private and public hospitals within Australia. To achieve adequate cover, you’ll need to take out a combination of cover with your health fund:
- Combined Cover. Private Health Funds cover you for around half the cost of your treatment expense, but you’ll need Hospital and General Treatment (Extras) cover. Your fund offers rebates for aspects of surgical services provided by podiatrists aligned to the Australasian College of Podiatric Surgeons (ACPS). These rebates cover theatre fees, bed stays in private hospitals and the costs of implantable prostheses such as pins, screws and plates.
Is podiatry covered by Medicare or Private Health insurance?
Professional fees of medical practitioners undertaking foot surgeries are rebated under the Medicare system, but they aren’t applicable to podiatric surgery. Medicare will pay a percentage of your podiatry fees if you have a referral from your GP and have been put on an Enhanced Primary Care (EPC) Plan, but you must fall into the following categories:
- You are a chronically ill patient.
- You have Diabetes or suffer from Vascular Disease.
Most private health funds cover about half (50%) the cost of your podiatry expense, given you have some form of Hospital and General Treatment (extras) cover. These rebates cover theatre fees, bed stays in private hospitals and the costs of implantable prostheses such as pins, screws and plates.
The Department of Veteran’s Affairs covers you for podiatry treatment but you must obtain a (D904) Referral from your GP prior to your first visit.
Work Cover Queensland will cover your Podiatry expenses if you’re injured on-site, but you’ll need a referral from your GP and a valid Claim Number specifically related to your injury.
Who can benefit from podiatry?
There are a range of reasons why you could choose to see a podiatric specialist. Here’s a list:
- Structural deformities, including bunions, hammertoes, painful flat foot and high arch deformity, bone spurs
- Heel pain
- Nerve entrapments
- Degeneration and arthrosis of the joints of the foot and ankle
- Skin and nail conditions
- Congenital deformities
- Trauma-related injuries, including fracture and dislocations and post traumatic arthrosis
Individuals, couples, families and single parent families all have the ability to receive cover through a health fund. You can choose a range of options, and pay monthly installments ranging from $19AUD, anywhere up to $30AUD to see you covered. This is achieved through a mix of Hospital Cover and General Treatment (Extras) cover.
If you choose the lesser form of cover and receive treatment in a private hospital, or in a single room in a public or private hospital, you’ll have to pay for the cost of the surgery yourself.
How do I claim podiatry on my health insurance?
You have two options to claim benefits after your podiatric treatment. This is ultimately through your health fund, or for those with exceptional circumstances, through Medicare.
For your Medicare claim to be successful you must have the following:
- You have a doctor’s referral. In order for Medicare to pay for a percentage of your medical costs for your surgery, you must ensure you have a referral from your GP, showing you have been placed on a health management plan, which determines you to be chronically ill, or have diabetes or vascular disease.
Without a doctor’s referral, you’ll be required to pay for your surgery, out of your own pocket. Once your medical procedure is complete, follow these steps to receive a Medicare rebate:
- Fill out a claim form. You must do this before you can receive your benefits.
- Lodge your medical claim at a Medicare office. Here the department will process and send your claim to your health fund for further processing. Once your claim is received and processed, it will be paid directly as a credit, and into your chosen account.
If you don’t fall into the exceptional circumstances category, you need to pursue your private health fund. A claim form can be found online, via your health fund's home page.
Here’s what you need to do before you claim benefits from your private health fund via your Hospital and General Treatment (Extras) Cover:
- Private practice provider certification. In order to claim benefits from your fund, ensure your treatment was undertaken by a private practice provider who is recognised and registered with your fund.
- Contact your fund. Do this before making a booking to confirm how much you can claim, and to check that your chosen provider is registered with your fund.
Wording to look out for around podiatric surgery
You need to fully understand certain wording surrounding podiatric services and what you will be covered for under your respective insurance. One to note is differences between the cost and cover associated with Inpatient and Outpatient treatment:
- Inpatient services. These are hospital treatments that result in a hospital admission.
- Outpatient services. Are dealt with in a private capacity in private rooms at a local specialist centre.
- Out-of-pocket fee. The cost you could be slapped with, if your doctor charges more than the Medicare Benefits Schedule service fee.
- Known Gap. This is where your fund will pay up to the minimum benefit, as set out in the government’s Prostheses List. This list includes pacemakers, defibrillators, cardiac stents, joint replacements, intraocular lenses and other devices that are surgically implanted, during a stay in hospital.
- No Gap. This is when your treatment is undertaken as part of your hospital treatment and you won’t have any out-of pocket expenses.
- Prosthesis. This is an artificial substitute for a missing body part, used for functional or cosmetic reasons or both. Surgically implanted prostheses are sometimes required during a medical procedure, such as a replacement lens for a cataract surgery, an artificial hip joint, a pacemaker, or a heart valve.
Cover for podiatric treatment come with strict conditions, so, putting your feet first can be a costly exercise. This is down to podiatry not being recognised under Medicare (unless you fall into the exceptional circumstances categories), and you’ll need a combination of cover to receive benefits from your private health fund.
It’s important to seek advice from your GP to see if you qualify for Medicare’s rebates and fully understand what kind of private health insurance or General Treatment (Extras) cover you can take out to ensure you don’t brunt the full cost of your surgery.
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