Medicare & Private Health Insurance Rebates for Telehealth!

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According to the Bureau of Statistics, in 2017 around 28% of Australians lived in rural or remote locations (outside of major cities). Due to the vastness of some of these locations, allied health services are few and far between. Cue the birth of SPOT Rural – a speech pathology service that provides expert clinical services to ANYONE, ANYWHERE through Telehealth. Telehealth can be defined as “the provision of healthcare remotely by means of telecommunications technology”. In other words, therapy delivered online. This model of service delivery is becoming increasingly recognised as a reliable and effective means of providing equal access to services, as people living in rural or remote towns aren’t restricted by their geographical isolation. Recent research in this area has provided ongoing support for the notion that speech pathology services provided via Telehealth are equally as effective as its in-person counterparts. There is just one problem for our rural and remote Australians receiving services via Telehealth… Medicare and private health insurance companies (PHI) are yet to jump on the bandwagon.

Currently, Medicare provides a Chronic Disease Management Plan (CDMP). A CDMP gives you five rebated speech pathology sessions, provided that you fit a certain criteria (which is decided by your GP). This rebate equates to approximately $250. However, this $250 is not accessible to any Australian accessing healthcare online. Similarly, many PHI’s do not provide rebates for speech pathology services delivered via Telehealth, despite offering rebates for in-person services. So, you may be wondering, if Telehealth research has suggested that this service delivery model is just as efficacious as those delivered in-person, then why are there discrepancies in rebates? Well, we were wondering the same thing, so SPOT Rural decided to dig a little deeper on this topic. We investigated the available rebates for Telehealth speech pathology services offered by the top 10 rated PHI companies in 2019. Unfortunately, results revealed that only four out of the ten PHI companies offer rebates for Telehealth, those being Bupa, GMHBA, Defence Health and CBHS. The companies who are yet to offer these rebates include Medibank, HCF, NIB, HBF, Australian Unity and Teachers Help. There is no other way to describe this finding than unacceptable.

Essentially, this finding means that rural and remote Australians are significantly disadvantaged when it comes to access of services, in both a physical and financial sense. Some of the families who connect with SPOT Rural live more than five hours away from their nearest speech pathologist, so weekly travel is not a feasible option. Similarly, even if a speech pathologist is within a reasonable distance, it is likely that the speech pathologist has a lengthy waiting list, and therefore access to the service is still restricted. However, it is important to recognise that Telehealth is not only used as a way to combat barriers related to distance. Telehealth is also a way to provide services to people with complex disabilities where the physical, cognitive, and emotional effort needed to attend a clinic may actually have a negative impact on the intervention itself (Theodoros, 2012). Likewise, Telehealth is a solution for busy families who have inflexible work schedules which are exacerbated by the need to attend a service in person (Theodoros, 2012). We know majority of SPOT Rural’s clients can relate to the examples outlined above, and so the option to receive therapy in the comfort of their own home is an invaluable therapeutic tool. So, as you can see Telehealth is the solution to many issues related to access, and it is for these reasons that SPOT Rural’s founder Heidi Begg decided to launch a Telehealth service. Disappointingly, even with the availability of a Telehealth service, without the option of rebates it is likely many families will continue to go without.

However, the inconsistencies in Medicare and PHI rebates was not the only shocking finding we uncovered during our search. When contacted, the majority of representatives from PHI companies who don’t offer Telehealth rebates were unaware of what Telehealth even was! This lack of understanding of health service delivery models is no doubt contributing to why Medicare and PHI companies have inconsistent rebates for Telehealth. At SPOT Rural, this signifies to us that education and advocacy are needed, for both the benefits of Telehealth and for equal access to services for all Australians.

At SPOT Rural, our mission is to provide choice, consistency, and continuity to all Australians. Without the option of rebates, the choice aspect of our mission is taken away from families, given the extra financial burden they bare for services, in comparison to their metropolitan counterparts. Similarly, consistency and continuity of services are jeopardised. Without the support of rebates, ongoing speech pathology may simply not be an affordable option, regardless of how in need a family may be. Once again, I reiterate – this is not acceptable!

Another important aspect to discuss is the rise and boom of technology that is now freely available in 2019. These days, the majority of workplaces incorporate and rely on technology on a day-to-day basis. It is undeniable that technological advances are at an all time high, allowing smooth and effortless interactions at the touch of a button. So, this brings us back to our original point – why is online therapy seen as sub-par to in-person therapy in the eyes of Medicare and PHI companies? It is time we start making better use of Telehealth in order to cope with the demands and growing need for speech pathology services across the country.

On this note, SPOT Rural decided to reach out to multiple state and federal political members to gain their thoughts on this topic. Unfortunately, we didn’t receive a single comment or response back. This was highly disappointing, as SPOT Rural is dedicated to fighting for equal access health services. Of course, we understand politicians have a lot on their plate, but in light of the ever changing political environment, isn’t the root of their job to support ALL Australians? Isn’t health care one of, if not the most important basic human right? So this begs the question, how can Australian leaders turn a blind eye to the disadvantages rural and remote Australians are facing when accessing healthcare? In a position statement made by the Allied Health Professions Australia (AHPA), they too question the inconsistencies in available Telehealth rebates. Just as we do at SPOT Rural, AHPA recognises that the decisions made by private health insurers are not controlled by the Australian government, however, they certainly do control Medicare rebates. Also, most PHI’s actually base their rebates off Medicare item numbers. Therefore, it is clear that the government needs to play a significant role in advocating for increased recognition of Telehealth services to both government and non-government funders.

So, to sum up this rather opinionated blog post, SPOT Rural will continue to advocate and educate on the benefits of Telehealth, and fight for all Australians to have the same financial support for health services. It is our hope that in the future Telehealth will be viewed in the same light as in-person services and not offered as ‘a last resort’. By doing this, it is hoped that Medicare & PHI’s will consider expanding the eligibility of rebates, therefore eradicating the discrimination against both Telehealth services, and geographically isolated Australians.

Thank you for reading!

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