Remedial Massage and Your Health Fund: The Provider Number That Decides the Rebate
It’s the middle of June, and you’ve just remembered the extras on your health cover. There’s a limit on massage you haven’t touched all year, and you’ve a feeling it starts again with the new financial year. So you book a ninety-minute session at a place in the shopping centre with a sign in the window: “Health fund rebates available”. It’s lovely. Then, at the counter, the claim doesn’t go through. Or it does, but later your fund tells you it wasn’t eligible after all. When I worked on a front desk, I saw that look of confusion more often than I can count. The sign wasn’t exactly wrong, but it skipped over what actually makes a massage claimable: the kind of treatment, the therapist’s qualification and association, and a provider number your fund recognises, on a receipt that shows what was done.
Remedial or relaxation
The first thing a fund looks at is the treatment itself, and there’s an important difference between remedial and relaxation massage.
A remedial massage is aimed at a specific problem. It usually starts with an assessment: the therapist asks about what’s bothering you, how long it’s been going on, and what makes it better or worse, and may check how you move. The treatment that follows is directed at that problem, and the therapist keeps notes about what they found and what they did.
A relaxation massage is about general wellbeing. It can feel wonderful, and there’s nothing wrong with booking one. But it isn’t treating a particular condition, and it isn’t claimable as remedial massage.
Funds decide by the service, not the room. A relaxation massage in a clinic is still a relaxation massage, and a remedial treatment doesn’t become something else because it happens in a shopping centre. What counts is what was actually done and who did it.
It’s worth being honest with yourself about which one you’re booking, too. If what you’d really like is an hour of quiet and a bit of pampering, book a relaxation massage and enjoy it. If there’s a sore shoulder you’ve been ignoring since the winter, tell the therapist about it when you book, so they can plan a remedial treatment around it.
Still on extras after the 2019 changes
You may remember the news in 2019 about natural therapies and private health insurance. From 1 April 2019, a list of natural therapies was excluded from private health insurance cover, including Bowen therapy, aromatherapy and others.
Remedial massage wasn’t on that list. The Association of Massage Therapists explained at the time that remedial massage and myotherapy were still eligible for health insurance rebates after the change.
That doesn’t mean every policy covers it. Whether you can claim, and how much, still depends on your own extras cover. If you’re not sure, check your policy before you book, or ask your fund directly.
When you ask, it helps to be specific. Ask whether your extras include remedial massage by name, how much of your limit you’ve already used this year, whether any waiting period applies, and when the limit starts again. Ask, too, whether massage shares its limit with any other service on your policy, so a second claim later in the year doesn’t come as a surprise. A two-minute call or a look in your fund’s app before you book is far less frustrating than finding out at the counter. And if remedial massage turns out not to be on your policy at all, at least you can decide whether to book anyway knowing the full cost.
The qualification and the association
This is the part that most people never see, and it’s where many claims are decided.
Funds don’t simply recognise anyone who calls themselves a massage therapist. Each fund sets its own criteria, and they usually involve two things: a recognised qualification in remedial massage, and membership of a professional association.
In Australia, the qualification to ask about is the national Diploma of Remedial Massage. A therapist who holds it will usually be happy to tell you where they studied.
The association matters because funds recognise therapists through professional associations. So it’s fair to ask which association a therapist belongs to, as well as where they trained.
Bupa’s requirements are a useful example of how this works in practice, though every fund sets its own. Bupa says it needs a diploma in remedial massage from an Australian registered training organisation, and membership of an accredited association. It doesn’t accept student membership. It also doesn’t recognise qualifications gained through distance-only or online study. Other funds may have different rules, so if you’re with another insurer, check theirs.
You don’t need to memorise any of this. But it explains why two therapists with similar hands can sit on different sides of the rebate line. One may have trained in a way their fund recognises and kept up their membership. The other may be every bit as skilled, but trained through a route that fund doesn’t accept, or let a membership lapse. Neither of those is something you’d notice from the table, which is why the question is worth asking before you book rather than after.
The provider number and the receipt
The provider number is what carries your claim. Each fund issues provider numbers to the therapists it recognises, so a therapist may be registered with one fund and not another.
The simplest thing you can do is ask before you book: “Are you registered with my fund?” Name the fund. A clinic that handles a lot of claims will be used to the question and can usually tell you straight away. If you’re looking for a therapist, the massage therapist listings are a good place to start, and it’s worth asking that question of whoever you call.
Then check the receipt. A receipt that supports a claim should show:
- the therapist’s name
- their provider number
- the date of the treatment
- the service provided
- the fee
If any of these is missing, ask for it before you leave. It’s much easier to fix at the counter than weeks later on the phone to your fund.
One thing to watch for: the provider number on the receipt should belong to the therapist who actually treated you. If you were treated by one person and the receipt shows another person’s number, ask about it. Claims are meant to reflect who did the work, and a mismatch is the kind of thing that can cause trouble with your fund later.
If the therapist you’d like to see isn’t registered with your fund, you can still book with them. You just won’t be able to claim the session on your extras, so it’s worth knowing that before you go rather than at the counter.
What a good session looks like
Most remedial massage appointments are straightforward and professional. Knowing what a good one looks like makes it easier to feel comfortable, and easier to recognise if something isn’t right.
A good session starts with questions. The therapist should ask about your health, any injuries or conditions, and what you’re hoping to get from the treatment. This is part of the assessment, and it’s also how they work out what’s safe for you.
Before treating any sensitive area, the therapist should explain what they’d like to do and why, and ask for your consent. You can say no, and you can change your mind at any time.
You should be draped with a towel or sheet throughout, with only the area being treated uncovered.
If you ask the therapist to stop, or to ease off, they should do so straight away. It’s fine to tell them at the start which areas you’d rather they didn’t treat, and it’s fine to say during the session that the pressure is too much. A good therapist wants that feedback, because it’s how they know whether the treatment is working.
If something during a session feels wrong, you’re allowed to stop it and leave. You don’t have to explain yourself in the moment. Afterwards, you can report it to the therapist’s professional association and to your health fund. If what happened was serious, you can also go to the police.
Physio, chiro or massage?
Massage isn’t always the right first stop, and a good remedial therapist will tell you if they think you need someone else. If you’ve had an injury, or a problem that keeps coming back, a physiotherapist may be the better person to see, and they can tell you whether massage would help alongside other treatment. And if the plan is mainly to get stronger and moving more, it’s worth looking at what a qualified personal trainer should have on paper before you sign up for sessions.
Ask Before You Lie Down
Before you book, ask whether the therapist offers remedial massage and is registered with your fund. When you arrive, expect questions about your health and an explanation of the treatment. Afterwards, check that the receipt shows the therapist’s name, provider number, date, service and fee. If anything is missing, ask for it before you leave. None of these questions is rude, and a therapist who’s registered with your fund will have heard them all many times. With those three things done, the June rush to use your extras can end with a claim that goes through, and a shoulder that feels a little better for it.
Sources: Association of Massage Therapists, Remedial massage and myotherapy still eligible for health insurance rebates, 2019 (https://blog.amt.org.au/index.php/2019/03/01/remedial-massage-and-myotherapy-still-eligible-for-health-insurance-rebates/); Bupa, Remedial massage therapy provider recognition (https://www.bupa.com.au/for-providers/ancillary/remedial-massage-therapy)