Health Insurance and Podiatric Surgery

In April 2007 the Federal Health Insurance Act was amended to allow Health Funds the ability to design more flexible insurance products. 

Previous federal legislative reform (2004/5) was specifically intended to encourage appropriate recognition of podiatric surgical services and equitable payment of rebate for these services. The Health Insurance Act and the National Health Act were amended to include Fellows of the ACPS in the same category as medical practitioners for the purposes of hospital admission. The explanatory memorandum to the amendment stated that hospital treatment provided by Fellows of the ACPS should be treated under applicable benefits arrangements “as they would if a medical practitioner provided a professional service”. These legislative reforms in combination with national registration of Fellows of the ACPS as specialists in foot and ankle surgery affirms that surgery performed by Fellows of the ACPS has been shown to be safe, clinically effective and cost effective

No individual or organisation should imply or suggest that the training and or skills of podiatric surgeons in Australia is in question. 

Hospital Costs 
To satisfy the intent of federal parliament when passing the legislation, health funds should consider equitable payment of hospital costs; including theatre costs and prostheses costs in association with admission for foot & ankle surgery performed by registered specialist Fellows of the ACPS. Many insurance companies comply with this intent – if your fund however discriminates against Fellows of the ACPS by not providing a product which equitably covers these cost you should consider firstly discussing the issue with your fund and if no positive outcome is noted you may complain to the Health Insurance Ombudsman. Please note that many services are only available on higher levels of hospital insurance. You may not be eligible for payments for podiatric services based on the level of cover you have paid for. 

Podiatric Surgical Fees and Anaesthetic Fees 
Despite there being no current Medicare benefit for podiatric surgery, under the new legislative arrangements insurance companies have the option of offering an insurance product which covers these fees. This is the same discretionary power the funds have for any provider. 

In Australia private health insurance companies are under no obligation to pay for podiatric services and associated hospital costs. However, many do, and they all have the choice to do so (as is the case for dental and medical procedures). This includes surgical procedures performed in hospital. Some health funds have demonstrated little understanding of the needs of their clients. If you find your fund does not cover podiatric surgery, you can change your health insurance to one that does choose to cover some or all of this service, lobby your fund to change its policy and/or provide you with what is called an “ex-gratia” payment. 

If you are told they cannot pay as the service is not Medicare rebated it is important to realise that this is an internal fund policy which can be changed if clients apply pressure. Such a position is in contradiction to the intent of the Federal Parliament. To facilitate change in the attitude of such health funds it is essential that you complain to the Private Health Insurance Ombudsman and your local member of parliament. 

Private Health Insurance Ombudsman 
Suite 2, Level 22
580 George Street
Sydney NSW 2000 

Complaints Hotline: 1800 640 695 (free call anywhere in Australia) 
Telephone: (02) 8235 8777
Facsimile: (02) 8235 8778 

 Podiatric Surgery – A better future for your feet