Making claims for therapy or assessment services
Some clients may be able to claim from a government or private organisation such as Medicare, Private health insurance or Department of Veterans Affairs or their care package. Please see below for more information.
The most important thing to note is that you will need to pay Umbo for the services you receive first, and then make the claim from the provider/funder. We are unable to process claims on your behalf. Please ensure that you are comfortable with this and have adequate funds to pay Umbo before proceeding as we cannot be responsible if claims are rejected due to no coverage.
Can I get a refund from Medicare?
There are some refunds available from Medicare for speech pathology and occupational therapy services, however, you need to meet the eligibility criteria and have a plan prepared by your GP. There are different types of plans which have different eligibility criteria (e.g. Enhanced Primary Care Plan, Chronic Disease Management Plan, Team Care Arrangement). The plan will normally be for a fixed number of sessions, and will allow you to claim a rebate of approximately $60 per session. This means that there will be a gap payable which can be calculated by finding out the hourly rate here, and subtracting the rebate. Speak to your GP to find out if you are eligible.
If you already have a Medicare plan please let us know so that we can ensure you are matched with a therapist who has a Medicare provider number. You will need to pay your invoice first in full. Once you have paid, you will receive a paid invoice email from us. You can then go onto the Medicare website and make a claim directly from Medicare for the rebate.
Though it is possible, we do not usually recommend using Medicare for assessments. This is because Medicare only allows you to claim once per assessment (as opposed to per session), and is therefore more effective when used each time with a number of therapy sessions.
For more information including item codes, please see the information here.
Can I claim on private health insurance?
Yes, if you have private health insurance that covers therapy services you can make a claim if you have that level of cover listed. If you plan to use private health insurance please let us know so we can ensure you are matched with a therapist who has a provider number and that you have spoken to your insurer first to understand your rebate. You will need to pay your invoice first and then make a claim directly from your insurer.
For more information including item codes, please see the information here.
Can I use my Aged Care Funding or DVA Funding?
You may be able to claim for Umbo’s services via your aged care funding or DVA funding but it is best you check with your team first to ensure that you are covered. You will need to pay your invoice first and then make a claim directly from your package.
Workers Compensation
If your injury or illness is work-related, you may be eligible to use workers’ compensation to cover the cost of your therapy sessions. You must first ensure you have notified your employer about your injury and lodge a workers compensation claim through your state’s workers’ compensation authority. Once your claim is approved, your doctor will need to provide a referral recommending therapy as part of your recovery plan. Please make sure you check with your workers compensation insurer that you have approval to cover the cost of your therapy sessions. Please note that some sessions may require a gap payment, so you’ll need to pay the invoice upfront and then claim reimbursement from your workers’ compensation insurer.
In some states, therapists must register with the relevant authority to provide sessions for workers’ compensation clients, which may cause delays in booking your first session while the registration is processed. To minimise delays, please notify us if you intend to use workers’ compensation for your sessions and provide the necessary documentation so we can get this process started as soon as possible.