Medical fees

A registered medical practitioner or nurse practitioner must complete a Disability Allowance medical certificate confirming the client's disability, and that the need for treatment is necessary. The certificate must confirm the client has a:

• disability that is likely to last at least 6 months or
• life expectancy of less than 6 months because of a terminal illness

The certificate must also confirm the treatment is beneficial and of therapeutic value and that the costs are:

• additional and
• ongoing and
• directly related to the client's disability

Treatment that is beneficial and of therapeutic value means the treatment may improve the client's condition, maintain the client's condition or prevent it from getting worse.

If the fees, or a portion of the fees, claimed are not covered by the Community Services Card or the High Use Health Card, ACC or other accident insurers, or medical insurance they can be included in Disability Allowance.

Note unless there are exceptional circumstances (e.g. when a public medical specialist doesn't exist in the client's region) Disability Allowance cannot usually be paid for private medical specialist fees. Public specialist fees are free.

Medical fees can also include the fee charged by the medical practitioner or nurse practitioner (or their teams) to complete a repeat prescription for ongoing conditions without the client attending a consultation (including faxing or electronically sending the prescription to the chemist).

This category can also include fees for the following services if a registered medical practitioner or nurse practitioner verifies the disability and need for the services on the client's Disability Allowance medical certificate:

• occupational therapy
• physiotherapy
• speech-language therapy (for adults)
• audiological
• orthotic
• podiatry
• dental services

Most general practices offer zero-fee general practitioner or nurse visits for children under 14 years old. The zero-fees scheme applies to:

• a standard daytime visit to a general practitioner or nurse at the usual practice where the child is enrolled or
• an after-hours visit to a participating clinic or
• injury-related visits covered by ACC

Zero fees does not cover fees charged by medical specialists, dentists or other medical services.

Some centres or clinics that offer zero fees for under 6-year-olds have the option of remaining on their current scheme or opting into the new scheme for under 14s.

The client must provide:

• a Disability Allowance medical certificate completed and signed by a registered medical practitioner or nurse practitioner and
• receipts as proof of their medical/therapy fees (one receipt is enough proof if it shows the regular cost of each visit, and the registered medical or nurse practitioner who signed the certificate indicates how often the client gets treatment)

Note if a fee has been charged by a health practitioner or chemist for the cost of a report or print out to verify medical fees or pharmaceutical charges, this fee or other administration related costs can be included as a cost for Disability Allowance.

It is not appropriate for MSD to approach the health practitioner directly for proof. The client should provide the receipts.

When a client has an overdue account with their health practitioner, any late payment fee is not an allowable cost for Disability Allowance.

Example 1

A client is charged $20 for their doctor's visit. This includes an administration fee of $5. This fee is deducted from the total if the account is paid within 7 days, and the account is reduced to $15.

If this is not paid within 7 days, the total charge of $20 can be included as a cost for Disability Allowance.

Example 2

A client has an overdue account with their doctor and has been charged a $10 late fee. The late fee is not an allowable cost for Disability Allowance as this fee is not a direct result of their health condition or disability but due to the client not paying the overdue account.

Example 3

A client goes to see a private rheumatologist specialist and applies for the cost to be covered by Disability Allowance. This is not an allowable cost for Disability Allowance as there is a publicly funded rheumatologist specialist in their region.