Acupuncture is covered under many private health extras policies in Australia. At my clinic in Alexandria the claim is not processed on the spot: you pay the fee, I email you an itemised invoice, and you submit it to your fund through its app or website. Whether your own policy covers it, and how much comes back to you, depends on the level of extras cover you hold, so it is worth a five-minute check before your first visit.
This post explains the moving parts in plain terms: the difference between extras and hospital cover, how claiming works after a visit, and the questions I suggest asking your insurer. If you are new to acupuncture in Alexandria, it also sets out what the appointments cost.
Extras cover, not hospital cover
Private health insurance in Australia comes in two parts. Hospital cover pays towards treatment as an admitted patient in hospital. Extras cover (sometimes called ancillary or general treatment cover) pays a rebate towards services outside hospital, such as dental, optical, physiotherapy and, on many policies, acupuncture.
Acupuncture sits under extras. If you hold hospital cover only, there is no rebate for a visit to the clinic. If you hold extras, look for acupuncture in your policy’s list of included services. Not every extras policy includes it, and the ones that do set different limits, so the policy document or your member portal is the place to check.
How claiming works at the clinic
Some clinics have a HICAPS terminal that sends the claim to your fund while you stand at the counter. This clinic does not. You pay the full fee at your appointment, and I email you an itemised invoice with everything your fund needs: my provider details, the service, the date and the amount. You submit it through your fund’s app or website, and the rebate is paid into your bank account, usually within a few days.
A few practical points:
- Have your fund’s app installed, or know your member login, so the claim takes a minute rather than an afternoon.
- The rebate amount is set by your fund and your level of cover, not by the clinic. Two people on the same day can receive different amounts.
- If a claim is declined (for example, because an annual limit has been reached), the fund will tell you why, and you can take the matter up with them directly.
Keep the invoice
Keep the emailed invoice with your records. Funds occasionally ask for it a second time, and it is the document to send if a claim is queried.
If the invoice has not arrived within a day of your visit, check your junk folder, then call or email the clinic and I will resend it.
What Medicare covers
Two things trip people up, so I will be direct about both.
Medicare does not cover acupuncture or naturopathy in this setting. There is no Medicare rebate for a visit to me, with or without a referral.
Cover for consultations other than acupuncture varies between funds and policies. If you are booking something other than an acupuncture appointment and a rebate matters to you, check your policy or ask me before you book.
Five questions to ask your fund
Rebates vary so much between funds and levels of cover that the only reliable source is your own insurer. A short call or a look at your online member portal will answer these:
- Is acupuncture included in my extras cover?
- What is my annual limit for acupuncture, and how much of it have I used this year?
- What is the rebate per visit?
- Are initial consultations and follow-up appointments rebated at different rates?
- How do I submit a claim: through the app, online or by email?
It is also worth asking about waiting periods if you have recently joined the fund or upgraded your cover. Extras waiting periods are common, and a claim made inside one will be declined.
What the appointments cost
So that you can work out your likely gap, here are the fees at the clinic:
- Initial acupuncture consultation: $180 for 60 minutes.
- Follow-up acupuncture: $130 for 60 minutes.
Your gap is the fee less whatever your fund returns. I do not quote rebate figures for any fund, because they change and because your level of cover decides them. More questions about payment and claiming are answered on the frequently asked questions page.
Ready to book?
If you have checked your cover and would like to come in for acupuncture at the clinic in Alexandria, you can book online or call (02) 9341 5775. Your itemised invoice will be in your inbox after the visit, ready to claim.
Ahil Naturopath/Acupuncture is a clinic located near Redfern, Alexandria and Waterloo. We also service areas across Sydney including Botany, Camperdown, Darlinghurst, Erskineville, Eveleigh, Mascot, Newtown, Rosebery, Surry Hills and Zetland.
We offer Acupuncture, Naturopathy, Herbal medicine, Traditional Chinese Medicine (TCM), Cupping, Gua Sha (Scraping) and Moxibustion services in South-East, Eastern and Inner City of Sydney.
This article is general information only and is not a substitute for individual advice from a qualified health practitioner. If you have a health concern, please see your GP or book a consultation.