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Aden's mummy
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PostSubject: Medicare and OT   Thu 4 Sep 2008 - 23:23

Anyone know if you can receive Medicare for OT? You can recvie it I think I read for ST, but what about OT and PT anyone please?
I had a call today from our Pead and she said I can receive Medicare help for OT. she will write a referral) for my other son Matt, but Aden will not receive the same.
For Matt there is two options, one under Mental health for 4 visitís the other under the new agreement for children with Autism. She is writing the referral under the Autism one. This will cover him for 4 visits for evaluation and then another 4 visits after the diagnoses.
She said Aden could fall under the Mental health category but itís questionable and she wouldnítí like toÖÖÖ..
We have private health cover but Iím still interested if anyone else has received Medicare for OT?
Thanks
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Amarlismum
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PostSubject: Re: Medicare and OT   Fri 5 Sep 2008 - 7:54

What you need to do is get your Doc/Paed to fill out the "Enhanced Primary Care form" its called the EPC Program through medicare and yes you are entitled to 5 visits to ST,PT or OT or the equivalent of $50 a visit(i think)per year. As far as im aware the one under metal health is for phycologists visits. You can always ring medicare and find out.
Remember its not a written referral you need, your doc has to fill in one of these forms, they will have one.
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Kat
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PostSubject: Re: Medicare and OT   Fri 5 Sep 2008 - 12:21

Not sure about OT- but when we had Ciara assessed by DADHC earlier this year they suggested we get an EPC done to pay for ST for her for 5 visits.

I am currently on an EPC for my back- I have had Physio done, just finished my 5 visits, have been reimbursed by medicare for $ 47 odd for each visit. They will only cover 5 visits within a 12mth period. We don't have private health insurance so once my visits are up (which is now) I have to wait until I move up on the waiting list for Westmead Hossie Physio (I have been on it since May already...... Sad )

Just looked at the form I have and OT is on the list- so I would say yes it would be covered under the EPC
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kookaburra
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PostSubject: Re: Medicare and OT   Fri 5 Sep 2008 - 17:59

I am 99.99% sure that you can medicare assistance for any service that the GP deems necessary. And I think Robyn is right about the amount, $50 a visit. However, and I may be wrong (hope I'm not) but I thought it was 5 visits per specialist.

We are not eligible here because we get free services through Disability SA but I know when I had Edward accessed for speech issues the Dr told me about the other services. I should have taken more notice cause now I can't remember all the details Wink
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Kat
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PostSubject: Re: Medicare and OT   Fri 5 Sep 2008 - 18:10

Straight off the form:-

GPs may choose to refer patients on a care plan for more than one service, up to a maximum of 5 services. (elsewhere on the form it adds the per year bit)

Services meaning allied health services- On the list of available AHP's are Aboriginal Health worker, Audiologist, Chiropractor, Chiropodist, Diabetes Educator, Dietitian, Mental health Worker, OT, Osteopath, Physio, Podiatrist, Psychologist and ST.

Here's a link to the website about it as well Smile

http://www.health.gov.au/internet/main/publishing.nsf/Content/health-medicare-allied-health-brochure.htm

Off the website:-

The five services can be provided by a single allied health professional or shared across different professionals.

.... I wish it was 5 services per specialist Very Happy

Oh and I was reimbursed $ 47.85 for each visit it cost me $ 50/visit (Neighbours rates- the PT is my neighbour Razz) and the schedule fee listed by medicare was $ 56.25.
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Aden's mummy
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PostSubject: Re: Medicare and OT   Fri 5 Sep 2008 - 18:12

Thanks heaps

I put this on other boards as well as the QLD yahoo group
I got this reply also, only the link isn't working Wink

You can access 5 visits per calendar year under medicare for any allied
health professional, including OT if you GP set up an "Enhanced Primary
Care" form.

Details are in the link below (have a look at the fact sheet). Not all GP's
seem to know about it so it could be good to print it out and take to your
GP.

http://www.health.gov.au/internet/main/publishing.nsf/Content/Allied+Health+
and+Dental+Care+initiative
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Aden's mummy
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PostSubject: Re: Medicare and OT   Fri 5 Sep 2008 - 18:13

Kat wrote:
Straight off the form:-

GPs may choose to refer patients on a care plan for more than one service, up to a maximum of 5 services. (elsewhere on the form it adds the per year bit)

Services meaning allied health services- On the list of available AHP's are Aboriginal Health worker, Audiologist, Chiropractor, Chiropodist, Diabetes Educator, Dietitian, Mental health Worker, OT, Osteopath, Physio, Podiatrist, Psychologist and ST.

Here's a link to the website about it as well Smile

http://www.health.gov.au/internet/main/publishing.nsf/Content/health-medicare-allied-health-brochure.htm

Off the website:-

The five services can be provided by a single allied health professional or shared across different professionals.

.... I wish it was 5 services per specialist Very Happy

Oh and I was reimbursed $ 47.85 for each visit it cost me $ 50/visit (Neighbours rates- the PT is my neighbour Razz) and the schedule fee listed by medicare was $ 56.25.

only just seen this thanks Kat
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Amarlismum
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PostSubject: Re: Medicare and OT   Fri 5 Sep 2008 - 18:25

Most Doctors should have the form, my neighbour has used this for her son's ST as they are not eligable for DADHC.
Im going to use it to take Amarli to see a Chiropractor for the first year after that i will use it to compensate what ST we do or dont get.

Quote :
(Neighbours rates- the PT is my neighbour Razz)
lmao
Im going to see our Doctor in the next couple of weeks, I'll let you know how it goes.
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Aden's mummy
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PostSubject: Re: Medicare and OT   Fri 5 Sep 2008 - 22:10

From Kats link
Quote :
A chronic medical condition is one that has been (or is likely to be) present for six months or longer. It includes conditions such as asthma, cancer, cardiovascular disease, diabetes, musculoskeletal conditions and stroke.


what do our kids get it for? is it the 'musculoskeletal condition" ? My DD has been Dx with this it's part of a few things, well i remember her rheumatoid Doctor using the word lol Iím hopeless at this stuff
the Pead mentioned she looked at a lot of different things on Medicare with the help of the OT but she didnít feel comfortable with using any of them. I'm sure the OT did she wants as much help for family's as possible. and our Pead is fantastic to also going to great lengths to phone around to find therapy help for my kids
so i donít get it, if you are all getting it, what the problem is.
though as i said the Pead did say some referrals can only be given out by a Pead and some only from a GP so this must be the GP one.
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Amarlismum
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PostSubject: Re: Medicare and OT   Sat 6 Sep 2008 - 8:38

As far as im aware Cathy, the GP can just do these forms for you.
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Kat
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PostSubject: Re: Medicare and OT   Sat 6 Sep 2008 - 13:54

Definitely a GP one- the form I have all says GP.

I don't have any of the conditions you mentioned Shocked I have a chronic back problem that has been going on for 10 years on and off so I qualify apparently-(it also helps that I have PCOS and Insulin resistance so see other specialists as required)

I don't know how our kids fit in it- all I know is it has been mentioned to me as a way we can get ST for Ciara whilst we are waiting for DADHC to get organised. I'd say that since they only say Chronic conditions "such as" that DS would be a chronic medical condition that would last longer than 6mths Rolling Eyes I'd say that list is only an example.
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