Medicare Eligible Services & Medicare Online Claiming
Fees for Appointments with our specialist paediatricians are eligible for Medicare rebates provided that you have a current referral letter from your GP or other specialist medical doctor.
After you have paid the full fee for your appointment we will lodge a claim on your behalf with Medicare Online. Provided your bank account details are registered with Medicare your rebate will be paid into your bank account usually on the next business day, but within three business days. Families should ensure they have provided bank details to Medicare, so the rebate can be paid into their nominated account.
Neonatal Care Invoices: We ask that the invoice amount is fully paid so that we can lodge a claim for Medicare rebates on your behalf so that your out-of-pocket costs are very quickly and substantially reduced. This helps the practice constrain costs and fees but, most importantly, ensures that each family receives all their applicable rebates in one step, and within 24 hours normally. The invoice shows the fees for the various items of care provided to your baby during their stay as a non-admitted baby in private hospital together with the standard gap. Safety Net rebates may apply to further reduce this gap. If a family has particular concerns about the invoice, we can advise strategies for further minimizing the wait for rebates and arrange for payment for one or two items at a time to limit the size of the outlay.
Medicare Rebates for Allied Health Services
Allied health appointments are only eligible for Medicare rebates if you have one of the following special referrals, where your referrer assesses your child as meeting the relevant criteria:
- Mental Health Care Plan (MHCP) from your GP OR Referral under the Better Access to Mental Health Scheme from your paediatrician or psychiatrist.
These referrals enable access to Medicare rebates for up to 10 visits in total per calendar year with a Psychologist and/or an Occupational Therapist .
Note: even if you have multiple plans/referrals/providers, you can only have 10 sessions in total per calendar year.
- Chronic Diseases Management Plan (CDMP)/Enhanced Primary Care Plan (EPC)/Team Care Arrangement (TCA) from your GP. This referral enables access to Medicare rebates for up to 5 visits per calendar year with the allied health professionals nominated in the plan.
- Referral under the Helping Children with Autism Scheme (HCWA) from your paediatrician or psychiatrist (must be initiated before your child turns 13 years of age)
- This referral enables access to Medicare rebates for up to 4 sessions for diagnosis/treatment planning and up to 20 therapy sessions before the child turns 15 years of age.
- Better Start for Children with Disability Initiative from your paediatrician or GP (must be initiated before your child turns 13 years of age)
This referral enables access to Medicare rebates for up to 4 sessions for diagnosis/treatment planning and up to 20 therapy sessions before the child turns 15 years of age.
Please see Visiting our Allied Health Professionals for more details on these plans.
Private Health Cover for Allied Health Appointments & HICAPS On-the-spot Claiming
Our HICAPS machine enables direct claiming with your fund on the day of your allied health appointment when you bring your health fund card. Levels of cover vary between and within funds so it is a good idea to contact your private health fund prior to your appointment to check if you have Extras cover for the particular service.
Private health funds do not cover appointments with medical doctors.
However, where Medicare coverage is not available to a family, their overseas health fund may provide cover for the costs of seeing a doctor. Your health fund can advise you about the rebates they will pay for the planned services.
National Disability Insurance Scheme (NDIS) Funding
Many of our allied health practitioners are able to provide NDIS services to children with funding packages. Please discuss this upon making your appointment and provide us with your child’s NDIS details and documentation prior to your visit as well as letting us know if you are self-managing or otherwise.
Paediatrics at Burnside is expanding its NDIS capacity and particularly aiming to increase services for assistance with pre-planning. This decision was made in light of a growing problem with planning processes that we have observed with families in our practice. Disability, developmental problems and early intervention remain core aspects of paediatric health and disability care and our providers are skilled in assessing need and guiding intervention.
A cancellation fee may be payable for non-attendance or late cancellations, less than 48 hours before the start of your appointment.
We do understand there may be extenuating circumstances when short notice cancellations may be unavoidable for unforeseen reasons such as sudden debilitating or contagious illness, a death in the family or similar matter preventing you keeping your booking commitment. In these cases we encourage you to contact reception staff as soon as possible to advise them of your situation. The practice does not regard work requests, changed social or parenting arrangements, for example, as sufficient to waive any cancellation fee.
At least a weeks notice allows the practice sufficient time to fill a booking that is being cancelled or rescheduled. Less than 48 hours notice makes it very difficult for our administrative team to offer the booking to families on our cancellation list. Families, hoping for an earlier appointment, also find it difficult and frustrating to make the necessary arrangements to take the appointment with less than 48 hours notice. Inadequate warning makes it difficult for the practitioner to adequately plan their use of the time.
When booked appointments are not filled, the costs of practice are increased. The practice and the various practitioners do try to absorb these costs but it is inevitable that there will be increased pressure on our fees that will impact on the many families who value and rely on our practice.
Why are there fees?
Our practice is private, well situated and equipped and aims to provide excellence in care for children and their families. We take pride in supporting the practice of our medical and allied health team in a best practice setting.
Our fees are set to help sustain the practice’s ongoing provision of high quality care. Affordability is also an important goal for us in setting fees and considered in light of the availability of various publicly funded clinics and providers. Fees are likely to increase over time with changes in Medicare rebates and increases in practice costs. The costs of providing quality health services are high. Health providers in private practice are remunerated for their work, only by private fees. Medicare (and sometimes for neonates, private health insurance) plays a big role in helping families afford these fees by paying rebates to substantially reduce out of pocket costs.
Many of our families have expressed appreciation for the services we provide. We will be striving to maintain these high standards into the future.
We are unable to bulk bill except in exceptional circumstances and only for a particular appointment, not as an ongoing option. Patients seeking bulk billing should consider attending appointments within the public system. Many of our paediatricians also consult in bulk billed or public clinics at various hospitals in Adelaide, including the Women’s & Children’s Hospital.
Healthcare, pension and concession cards do not routinely attract fee concessions. Cardholders are able to access a range of other government benefits which assist significantly with other aspects of family healthcare costs.
If you are concerned about the fees generally, or for your booking please call us. The practice is mindful that occasionally families may require concessional arrangements and concerns about fees should be discussed with our Practice Manager, Angela. We ask that any concerns are raised prior to your appointment, and so as to allow time for unhurried and private conversation.
Payment of Fees
Appointments in rooms: Payment of fees is required on the day of your appointment. Fees normally involve a gap or out of pocket amount after you receive your Medicare rebate. Once paid, staff will lodge a claim for you and rebates are normally paid into your bank account within about 24hours. Fee and out of pocket advice is given on assumption that a valid referral has been provided for your appointment. Please visit our pages on visiting our medical & allied health professionals for information about relevant referrals.
Neonatal Care Invoice: This invoice is for the care of your newborn by your paediatrician in Burnside or Calvary Hospital. It is posted to you after you go home with baby, ideally within the first month at home, although delays may occur. Payment of the full amount is requested within 14 days of the invoice but may be extended to baby's 6th week if needed. Full payment of the items on the invoice allows us to claim all your applicable rebates in one quick step and your payment will be reduced to the gap amount within a few hours of the initial outlay. If difficulties are expected, the practice may arrange for itemized payments over several days.
What is the fee for my appointment?
Reception staff can help with general advice on fees over the phone. When your child is booked for a consultation and is new to the practice or where they have not been seen for some time, staff will explain the likely fees and the out of pocket costs. Further information may be sent to you via email or post if needed. If your child is booked for a review appointment, and you would like information about fees, feel very welcome to ask. Again, staff can usually indicate several possible fees but do give definite advice out the out of pocket cost for the appointment. Again, this information may be sent by post or email if needed.
Our fees policy provides for predictable out of pocket costs.
Some review appointments are quite involved whilst others are more straightforward and are billed to reflect this. Families may see a different doctor in the practice from time to time and should be aware that fees and out of pocket costs may be a little higher or less than they are usually billed.