Podiatry and Private Health Insurance
Learn more about navigating podiatry treatment and private health insurance.
Foot health is often overlooked in our daily lives until pain or injury brings it to the forefront. Podiatry, (also known as chiropody) involves the specialised care for the foot, ankle, and lower leg, and isn’t just about treating problems. Podiatrists can help support healthy foot and lower limb function to prevent issues before they arise, unlocking long-term mobility, and empowering you to live an active, pain-free life.
At GMHBA, we believe your health starts from the ground up, literally! Our extras covers are designed to help keep you in top shape. In this article, we explore health insurance for podiatry empowering you to prioritise what’s important for your health and wellness.
Understanding podiatry and private health insurance coverage
Podiatry care can be important across all stages of life, from young children to older adults. People of any age can experience issues that require the expertise of a podiatrist. From addressing developmental concerns in children that may affect their growth and wellbeing such as flat feet, to sports injuries in adolescents and adults, and age-related conditions such as arthritis or complications of vascular disease in older individuals.
Treatment by a podiatrist is generally not covered under standard Medicare coverage, except for chronic conditions managed under an enhanced primary care plan from a GP (general practitioner). For most people, podiatry services are an out-of-pocket expense.
Selecting private health insurance extras cover that includes podiatry can provide benefits and reduce out-of-pocket expenses.
Why choose extras with podiatry cover with GMHBA?
Podiatry care can be costly, especially when it involves corrective treatments such as custom orthotics, which are not covered by Medicare. These are costs you will have to pay on top of consultation and treatment fees, which can quickly add up, particularly for individuals requiring ongoing treatment.
At GMHBA, selecting extras cover that includes benefits toward podiatry treatment can help to reduce out-of-pocket expenses for consultations and corrective orthotics. GMHBA’s extras cover provides support so members can focus on achieving better health outcomes without compromise.
Contact us to find the best cover for you.
Navigating podiatry cover
In Australia, it is not necessary to have a GP referral for general treatment from a podiatrist (except for treatment under a GP primary care plan). This enables patients to directly seek podiatry care for common foot and lower limb issues such as heel pain, nail conditions, bunions, and sports injuries. Podiatrists are professionals trained to diagnose, treat, and prevent these conditions, providing services like orthotic therapy, minor surgical procedures, and footwear advice. Individuals can book an appointment with a podiatrist at their convenience for the treatment of discomfort or for overall foot health maintenance.
What does private health insurance cover for podiatry?
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What’s covered under hospital cover |
What’s covered under extras cover |
What’s not covered by private health insurance |
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GMHBA hospital cover will cover hospital admissions as a private in-patient for the investigation and treatment of conditions affecting the foot and/or ankle. When treated by a registered podiatric surgeon, and podiatric surgery is an included clinical category, limited cover will apply for:
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If you have podiatry listed on your extras policy, you may be able to claim a benefit towards any podiatry item number including:
Please refer to the member factsheet and waiting periods.
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We don’t cover some podiatry or podiatric surgery items such as:
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Cost considerations: Podiatry services and orthotics
Orthotics, custom made shoe inserts, are widely used by podiatrists to treat foot and lower limb conditions such as plantar fasciitis, flat feet, and sports injuries by improving foot function and alleviating pain. While their costs can be significant, extras cover that includes orthotics benefits can help reduce the overall cost by providing partial reimbursements under podiatry benefits.
The cost of orthotics can vary as prices are set by your podiatrist. Your benefit on orthotics can also vary depending on the type and level of your private health insurance cover. Please refer to the product fact sheet for further information.
Choosing a plan with podiatry cover ensures that you can access orthotics more affordably, supporting both treatment and preventive care for better foot health.
What is podiatric surgery?
Podiatric surgery involves the surgical treatment of foot and ankle conditions by a registered podiatric surgeon (trained podiatrists with additional training in surgery).
Podiatric surgeons diagnose and treat a range of foot and ankle disorders, that may include:
- Structural deformities
- Pain
- Nerve entrapments
- Soft tissue problems including tendon and ligament injuries
- Degenerative conditions such as osteoarthritis of the foot and ankle
- Congenital conditions such as clubfoot
- Trauma related injuries such as fractures or ligament tears
Podiatric surgery is included in a range of GMHBA hospital covers when you are admitted as a private patient, this could be in a public or a private hospital.
There are two types of surgeons who can perform podiatric surgery: podiatric surgeons and orthopaedic surgeons. The main difference between the two specialties is that orthopaedic surgeons specialise in the medical and surgical management of all bones and joints in the body, while podiatric surgeons focus on the foot and ankle only. Although they can perform similar procedures, orthopaedic surgeons can claim benefits from Medicare, whereas podiatric surgeons cannot claim Medicare benefits.
It’s important to note that GMHBA’s hospital cover includes the investigation and treatment of conditions affecting the foot and/or ankle, provided by a registered podiatric surgeon. Benefits are limited to only cover hospital accommodation and the cost of a prothesis per the government approved prescribed list of medical devices and human tissue products list. Medical services such as pathology, radiology, and the anaesthetist or the surgeons' account in respect to podiatric surgery are not covered under hospital products.
Podiatric surgery is often associated with significant out-of-pocket expenses. While Medicare typically does not cover most podiatric surgical expenses, private health insurance can offer limited benefits that can ease the financial burden. Additionally, if your policy includes extras cover for podiatry, you may also be eligible for benefits on consultations and certain podiatry item numbers. It is essential to review your policy details to understand what is included.
To find a health cover for your needs, or for more information on what is included in your current hospital policy, contact us.
All podiatric surgery procedures are subject to a 12-month waiting period.
Paying for podiatry: Choosing between Medicare and private health insurance
Choosing between Medicare and private health insurance is something to consider when looking into your options for medical care. Medicare typically does not cover the associated costs for any services provided outside of a hospital, often known as ancillary or extras treatments. This includes podiatry, especially where surgeries or specialised procedures are performed. Private health insurance, on the other hand, can support some benefits towards out-of-pocket expenses, like extras cover paying benefits towards podiatry item numbers, or hospital cover helping for inpatient care like prosthesis and room charges. Knowing what’s included in your health insurance policy can make it easier to pick what works best for your budget while still getting the care you need.
Private health insurance cover for seeing a podiatrist
Private health insurance extras cover can provide benefits for podiatry services performed outside of a hospital setting, including consultations and treatments by registered podiatrists. For podiatry treatment it is important to verify the coverage on your policy, understand the benefit limits, and inquire about any specific exclusions in your policy.
For podiatric treatment in a hospital setting, your hospital cover should include the clinical category for podiatric surgery. If your surgery is with a registered podiatric surgeon, limited benefits towards hospital accommodation or the cost of prosthesis may apply. You may also be treated by an orthopaedic surgeon, in which case medical benefits will also be covered.
FAQs about podiatry and health insurance
Podiatry is only eligible to be claimed on Medicare by those with chronic conditions managed under an enhanced primary care plan from a GP.
Costs associated with podiatry can vary, based on your location and the treatments required. It’s best to ask your podiatrist for further information on costs associated with treatment and services. Our team are here to help if you want to know what your cover provides, we recommend asking your podiatrist for the service code before contacting us so we can best answer your questions.
Absolutely, seeing a podiatrist can be valuable if you are experiencing persistent foot, ankle, or lower limb issues.
Podiatrists are specialists trained to diagnose, treat, and prevent a wide variety of foot and lower leg conditions, from common problems like bunions, ingrown toenails, and heel pain to more complex issues such as diabetic foot complications or injuries resulting from sports and accidents.
Timely consultation with a podiatrist can help address discomfort, improve mobility, prevent minor concerns from developing into serious problems, and assist with improving your overall quality of life. Even if your symptoms seem minor, seeking expert care can lead to better long-term outcomes and keep you moving with confidence.
You should consider seeing a podiatrist if you are experiencing persistent or recurring issues with your feet, ankles, or lower limbs, such as:
- Pain
- Injury
- Deformities (like bunions or hammertoes)
- Ingrown toenails
- Foot-related complications from diabetes
- Concerns with walking and mobility
Podiatrists specialise in diagnosing and treating conditions specific to the feet and lower legs and are trained to provide both conservative treatments and surgical interventions. It’s advisable to see a GP or doctor for broader health concerns, such as systemic symptoms (fever, widespread swelling, infection that might affect more than your foot), or if your foot issues could be linked to overall health conditions. Your doctor can assess your general health, manage complex conditions, and refer you to a podiatrist or other specialist if needed.
In summary, consult a podiatrist for foot and ankle specific concerns, and see your doctor for general health issues or if you are unsure where your symptoms originate. If you have a chronic medical condition affecting your feet, like diabetes, it’s often beneficial to have both your GP and a podiatrist involved in your care.
Podiatric surgeons may perform surgeries to address various issues, including:
- Structural abnormalities such as bunions, hammertoes, flat feet, or high arches
- Bone spurs
- Pain in the heel
- Problems involving nerves and tendons
- Nail disorders
- Injuries caused by trauma, such as fractures or broken bones
Members new to private health insurance undergoing podiatric surgery with extras cover typically face a 12-month waiting period before they can claim benefits. While serving any waiting periods, patients can plan their surgery, consult with their podiatric surgeon, and confirm their cover.
Podiatric surgery under hospital cover is subject to the pre-existing condition rule. This rule determines whether benefits will be paid for hospital-related costs. It's important to note if the procedure is deemed to be a pre-existing condition this will mean that hospital accommodation will not be covered. Although, this does not apply to the extras portion of your cover the 12-month waiting period for podiatric surgery will still apply, this also means that if you're still serving your 12-month waiting period under extras, you won't receive any benefits for the procedure.
Recovery time for podiatry surgery varies by procedure. It’s best to ask your podiatric surgeon for an accurate timeline of what to expect, but we’re here to help if you need to know more about your health cover.
Podiatric surgery provided by a podiatric surgeon does not qualify for Medicare benefits, which is why GMHBA cannot pay benefits towards any Medicare benefit scheme (MBS) item numbers associated with the surgeon, anaesthetist, assistant surgeon.
Health Funds are only required to pay limited benefits towards hospital fees and the cost of any prosthesis that is associated with the surgery which is also listed on the government approved prescribed list of medical devices and human tissue products list. It is not mandatory for a health fund to pay benefits towards medical costs. Any benefits paid will need to be provided by a podiatric surgeon registered with AHPRA (Australian Health Practitioner Regulation Agency).
For further information you can visit the PHI Ombudsman website.
For GMHBA to pay benefits towards the available components of podiatric surgery, the eligibility criteria that applies is as follows:
- Members hospital cover needs to include the podiatric surgery clinical category
- Surgery must be provided by an AHPRA registered podiatric or orthopaedic surgeon
- Member's must have served waiting periods to be eligible for benefits to be paid towards podiatric surgery