At Doctors’ Health Fund, we strive to keep our claims process quick and easy to understand for all members. Your claiming experience is one of our key priorities.

This quarter we address some common questions asked by our members when claiming Extras services:

1. When can I claim a mental health service from my health fund, and when do I claim it through Medicare?

All our Extras Covers pay benefits towards mental health services. This includes when you see a registered psychologist or counsellor for a private consultation. Medicare also provide benefits towards mental health services, as part of their Mental Health Plan*.

It is important to be aware that we are unable to pay an additional benefit on services that have also received a rebate from Medicare or another Government department.  

Your claim cannot be paid if the invoice contains a Medicare item number, as this suggests your claim has or will be claimed through Medicare. We encourage you to speak with your therapist to ensure they bill your service correctly to allow it to be claimed as a private consultation with us.

2. What is an Official Pharmacy Receipt?

We often find that members don’t provide enough information when claiming for eligible non-PBS pharmacy items.

An Official Pharmacy Receipt is required to process any pharmacy claim. This document includes crucial information including patient name, script number, item description, supply date, and fee paid. We require this official receipt to ensure any eligible benefits are paid to the correct person on your policy.

Official Pharmacy Receipts can be requested from your pharmacist at the time of purchase.  

3.  I am interested in your Health Management Program. What services does this include and am I covered for this under my current level of Extras cover?

We are often asked by members if they can claim for Exercise Physiology visits, and other services such as Class Physiotherapy, Acupuncture or Exercise classes conducted at a gym or by a personal trainer. These services can be claimed as part of a Health Management Program,  a service covered only with our Total Extras Cover. This is a unique inclusion of our highest level of Extras Cover, that provides benefits for services prescribed by your doctor to treat or manage a specific health condition. A form needs to be completed by your doctor and sent to us for approval before the services are received. For more information and to download our Health Management Program form, click here.  

4. I have purchased a medical device from an overseas online provider. Can I claim this under my Aids and Appliances limit?

Private Health Insurance regulations restrict us from paying claims for medical devices purchased from overseas online providers. Our Extras Covers pay a generous 75% of the cost of Fund-approved aids and appliances up to the annual limit on your specific policy. However, to be eligible for health fund benefits, the device must be provided from an Australian company with an ABN, as your private health insurance cannot cover any overseas services. More information can be found on claiming Aids and Appliances here.

*Disclaimer: Please speak with your GP regarding the conditions of any Medicare benefits that may be available to you, your eligibility and to obtain their referral. The health fund cannot provide advice on any Medicare benefits for allied health services.