Therapist Hub

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

By August 3, 2018 No Comments

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 

Fund NameAllows Rebates for Mobile Massages?If yes, which modalities?Minimum Qualifications to get this Provider NumberOther Information
ACA Health Benefits Fund LtdYesRemedial MassageARHG: Remedial | Minimum Diploma in Remedial Massage, and a minimum of 200 hours of supervised clinical practice be completed
ANZYesRemedial MassageBUPA: Providers must hold at least $2 million professional indemnity insurance per claim. BUPA issues a separate provider number to each practice address. Must have a minimum of Diploma in Remedial Massage.Your association will notify you of your provider number via email or mail. If you have more than one practice address you will receive separate numbers for each address. BUPA has a maximum 4 clinics for all modalities;
Australian Health Management (AHM)YesRemedial Massage ConsultationsDuration Requirement: You will need to have completed a Diploma in Remedial Massage over at least one year full-time or 18 months part time. You will also need a letter from you RTO stating that your training program meets the specific requirments.AHM requires you to contact them to obtain your provider number/s. You can contact them via email info@ahm.com.au or phone 134 246. If you have more than one practice address you will receive separate numbers for each address.
Your ATMS Number will be your provider number, unless
you wish to have online claiming. You will then need to contact
AHM directly for the new provider number.
Australian UnityYesRemedial Massage ConsultationsRemedial : Minimum Diploma of Remedial MassageAustralian Unity will notify you of your provider number/s via mail. If you have more than one practice address you will receive separate numbers for each address. Australian Unity requires Professional Indemnity Insurance (to at least $2 million) and Public Liability Insurance (to at least $10 million)
Budget Direct HealthYesRemedial Massage
BUPA (including MBF, HBA, Mutual Community, AXA, Super Members Health Plan, Bank SA, MBF Alliances – NRMA, SGIO, SGIC, American Express Card Members Health Insurance, CSP Health Plan, and National Mutual Health Insurance)YesRemedial MassageBUPA: Providers must hold at least $2 million professional indemnity insurance per claim. BUPA issues a separate provider number to each practice address. Must have a minimum of Diploma in Remedial Massage.Your association will notify you of your provider number via email or mail. If you have more than one practice address you will receive separate numbers for each address. BUPA has a maximum 4 clinics for all modalities;
CBHSYesRemedial, Swedish, and Sports, TherapeuticTherapeutic | Minimum Cert IV Massage
Remedial | Minimum Diploma in Remedial Massage
Some variation of your personal association number will be used as your provider number. This number is used for all practice addresses registered with the CBHS.
Cessnock District Health Benefits FundYesRemedial MassageARHG: Remedial | Minimum Diploma in Remedial Massage, and a minimum of 200 hours of supervised clinical practice be completedSome variation of your personal association number will be used as your provider number. This number is used for all practice addresses registered with ARHG.
CUA HealthYesRemedial massageARHG: Remedial | Minimum Diploma in Remedial Massage, and a minimum of 200 hours of supervised clinical practice be completedSome variation of your personal association number will be used as your provider number. This number is used for all practice addresses registered with ARHG.
Defence HealthYesRemedial MassageARHG: Remedial | Minimum Diploma in Remedial Massage, and a minimum of 200 hours of supervised clinical practice be completedSome variation of your personal association number will be used as your provider number. This number is used for all practice addresses registered with ARHG.
Doctors’ Health FundYesRemedial MassageSome variation of your personal association number will be used as your provider number. This number is used for all practice addresses registered with the Doctors’ Fund.
Frank Health InsuranceYesRemedial Massage
GMHBA Health InsuranceYesRemedial MassageARHG: Remedial | Minimum Diploma in Remedial Massage, and a minimum of 200 hours of supervised clinical practice be completedSome variation of your personal association number will be used as your provider number. This number is used for all practice addresses registered with ARHG.
Grand United HealthYesRemedial MassageRemedial | Minimum Diploma in Remedial MassageGU Health will notify you of your provider
number/s via mail. If you have more than one
practice address you will receive separate numbers
for each address.
HBFYesRemedial MassageRemedial | Minimum Diploma in Remedial Massage
HCF (including former Manchester Unity policies)NoDuration Requirement: You will need to have completed a Diploma over at least one year full-time or 18 months part time. HCF requires a minimum of 200 hours of supervised clinical practice be completed as part of the Diploma. You will also need a letter from you RTO stating that your training program meets these specific requirments.HCF does not issue provider numbers. Use your
association member number on all receipts
Health Care Insurance LimitedYesRemedial MassageARHG: Remedial | Minimum Diploma in Remedial Massage, and a minimum of 200 hours of supervised clinical practice be completedSome variation of your personal association number will be used as your provider number. This number is used for all practice addresses registered with ARHG.
Health Cover DirectYesRemedial MassageBUPA: Providers must hold at least $2 million professional indemnity insurance per claim. BUPA issues a separate provider number to each practice address. Must have a minimum of Diploma in Remedial Massage.Your association will notify you of your provider number via email or mail. If you have more than one practice address you will receive separate numbers for each address. BUPA has a maximum 4 clinics for all modalities;
Health Insurance Fund (HIF) YesRemedial MassageARHG: Remedial | Minimum Diploma in Remedial Massage, and a minimum of 200 hours of supervised clinical practice be completedSome variation of your personal association number will be used as your provider number. This number is used for all practice addresses registered with ARHG.
Health PartnersYesRemedial Massage
Health.com.auYesRemedial MassageARHG: Remedial | Minimum Diploma in Remedial Massage, and a minimum of 200 hours of supervised clinical practice be completedSome variation of your personal association number will be used as your provider number. This number is used for all practice addresses registered with ARHG.
Latrobe Health Services NoARHG: Therapeutic Massage- Minimum Cert IV Therapeutic Massage, Remedial Massage- Minimum Diploma in Remedial Massage, and a minimum of 200 hours of supervised clinical practice be completedSome variation of your personal association number will be used as your provider number. This number is used for all practice addresses registered with ARHG.
Medibank PrivateYesRemedial MassageDuration Requirement: You will need to have completed a Diploma over at least one year full-time or 18 months part time. You will also need a letter from you RTO stating that your training program meets the specific requirments.Your association will notify you of your provider number via email. If you have more than one practice address you will receive separate numbers for each address, up to a maximum of three addresses.
Mildura District Hospital FundNoARHG: Remedial | Minimum Diploma in Remedial Massage, and a minimum of 200 hours of supervised clinical practice be completedSome variation of your personal association number will be used as your provider number. This number is used for all practice addresses registered with ARHG.
Navy HealthYesRemedial MassageARHG: Remedial | Minimum Diploma in Remedial Massage, and a minimum of 200 hours of supervised clinical practice be completedSome variation of your personal association number will be used as your provider number. This number is used for all practice addresses registered with ARHG.
NIB Health FundsYesRemedial MassageRemedial | Minimum Diploma in Remedial Massage –nib does not issue provider numbers. Use your association
member number on all receipts.
Nurses Midwives HealthNo
onemedifundYesRemedial MassageARHG: Remedial | Minimum Diploma in Remedial Massage, and a minimum of 200 hours of supervised clinical practice be completedSome variation of your personal association number will be used as your provider number. This number is used for all practice addresses registered with ARHG.
Peoplecare Health InsuranceYesRemedial MassageARHG: Remedial | Minimum Diploma in Remedial Massage, and a minimum of 200 hours of supervised clinical practice be completedSome variation of your personal association number will be used as your provider number. This number is used for all practice addresses registered with ARHG.
Phoenix Health FundYesRemedial MassageARHG: Remedial | Minimum Diploma in Remedial Massage, and a minimum of 200 hours of supervised clinical practice be completedSome variation of your personal association number will be used as your provider number. This number is used for all practice addresses registered with ARHG.
Police Health Fund YesRemedial MassageARHG: Remedial | Minimum Diploma in Remedial Massage, and a minimum of 200 hours of supervised clinical practice be completedSome variation of your personal association number will be used as your provider number. This number is used for all practice addresses registered with ARHG.
Queensland Country HealthYesRemedial MassageARHG: Remedial | Minimum Diploma in Remedial Massage, and a minimum of 200 hours of supervised clinical practice be completedSome variation of your personal association number will be used as your provider number. This number is used for all practice addresses registered with ARHG.
St Luke’s HealthNoARHG: Remedial | Minimum Diploma in Remedial Massage, and a minimum of 200 hours of supervised clinical practice be completedSome variation of your personal association number will be used as your provider number. This number is used for all practice addresses registered with ARHG.
Teachers HealthNoARHG: Remedial | Minimum Diploma in Remedial Massage, and a minimum of 200 hours of supervised clinical practice be completedSome variation of your personal association number will be used as your provider number. This number is used for all practice addresses registered with ARHG.
Transport Health FundYesRemedial MassageARHG: Remedial | Minimum Diploma in Remedial Massage, and a minimum of 200 hours of supervised clinical practice be completedSome variation of your personal association number will be used as your provider number. This number is used for all practice addresses registered with ARHG.
WestfundNoARHG: Remedial | Minimum Diploma in Remedial Massage, and a minimum of 200 hours of supervised clinical practice be completedSome variation of your personal association number will be used as your provider number. This number is used for all practice addresses registered with ARHG.

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