Does Private Health Insurance Cover Hand Therapy?

In Australia, as you may know, health insurance has
different tiers – Basic Hospital cover as the bare minimum, Bronze, Silver, and Gold cover. The higher the tier, the more surgeries, chronic illnesses,
preventative procedures, mental health treatment, and fertility procedures (such as IVF) are covered. Of course, this costs more per month or year as a result.

However, to give consumers more incentive to take up health insurance (apart from many tax advantages and rebates) is extras cover. This gives people access to a range of complimentary therapies and non-hospital
health benefits such as covering dental work, optometry, massage and musculoskeletal therapy, physiotherapy, psychotherapy, and even naturopathic treatments.

However, does private health insurance cover hand therapy? This may be a crucial question for people who are living with chronic pain or disabilities who want to regain their independence. However, there may be a distinction between the two in the eyes of insurers.

What is occupational therapy vs hand therapy

Occupational therapy is a catch-all term for any type of
therapy that helps people perform their daily tasks due to ongoing or acute movement disorders. This may include assisting with one’s grooming routine, cooking and cleaning, hobbies, work, or school commitments, and going about one’s normal everyday business.

In some cases, OT may be required as a rehabilitation method until the patient is well enough to manage on their own or is ongoing for people with intellectual or physical disabilities. OT is also common among children with learning difficulties. This may be part of an NDIS supported independent living plan – though not all people who need OT qualify.

Hand therapy focuses on assessing and treating conditions of the hand, wrist, and upper limbs. This can be conducted by occupational therapists as well as physiotherapists for a range of conditions such as arthritis of the hand and wrist, Carpal Tunnel Syndrome, Mallet finger, Elbow tendinopathy (tennis elbow), finger sprains and dislocations, flexor tendon injuries, and so on. 

Hand therapy is a subset of occupational therapy, there is crossover with physiotherapy. A physiotherapist can help remedy a range of hand and wrist symptoms in the same way an occupational therapist can. This all depends on what they have studied, what their resulting qualification is, and what they have specialised in – in this case, hand therapy.

This can become confusing when all one is looking for is a hand therapist!

So, who does what?      

• Some occupational therapists can provide hand therapy, though it depends on their specialisation.
• These therapists are usually referred to as “hand therapists.”
• Physiotherapists can provide hand therapy services if that is part of their skill set.
• These physiotherapists may also be referred to as “hand therapists.”
• Any therapist accredited by the Australian Hand Therapy
  Association is considered a hand therapist if they demonstrate high levels
  of competency in the skill.
• Both occupational therapists and physiotherapists may be accredited by the AHTA.

Medicare and occupational therapy

Occupational therapy is funded under the Medicare Benefits Schedule under an Enhanced Primary Care Plan. They must be referred to a qualified therapist by their GP. The current benefit is $58 from the provider’s scheduled fee. The patient is also allowed to access the rebated service up to five times per calendar year and can be comprised of different types of services (e.g., all occupational therapy or one at a physiotherapist and four at an occupational therapist.)

If you require more than five visits per calendar year, you will either need to pay out of pocket or find a health insurance provider that offers rebates on occupational therapy. The same applies to physiotherapists with the same fee, rebate, and number of visits per year.

A GP may be reluctant to sign up someone in relatively good health to an Enhanced Primary Care Plan and may reserve the slots for those with chronic health conditions. Therefore, people seeking “non-urgent” hand therapy should consider taking out private health insurance extras cover as a precaution. Be aware that you may be subject to waiting periods before you make
any claims. This varies by insurer and your pre-existing conditions.

Checking that your provider covers hand therapy

Much like hospital cover, extras cover comes in comparable tiers. The higher the tier, the more services are covered. In many patient experiences, booking an occupational therapist results in their claim being rejected, as they are covered for physiotherapy and not occupational therapy.

This can be confusing for someone who is seeking relief for hand injuries or ailments. When you compare extras cover, you need to see if the policy explicitly covers physiotherapy AND occupational therapy.

Alternatively, when booking hand therapy, you need to ask whether your therapist is an occupational therapist or physiotherapist to ensure you get the rebate you are entitled to. If you are not covered for occupational therapy, you may want to find a hand therapy clinic that also has physiotherapists as an alternative. However, both professionals bring a unique perspective and you may want to consult seeing each at different times.

This way you can rest assured that you get the rebate you need when seeking hand therapy whether it’s from an occupational therapist or a physiotherapist – although they provide the same services.

Just keep in mind that not every “hand therapist” is made the same – they could be a physiotherapist or an occupational therapist – and your private health rebate depends on how your extras cover is structured.