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

Previous legislative reform intended 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 podiatric surgeons 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 podiatric surgeons should be treated under applicable benefits arrangements "as they would if a medical practitioner provided a professional service".

Both in Australia and internationally, surgery performed by podiatric surgeons has been shown to be safe, clinically effective and cost effective. The successful passing of the legislative reform in Australia affirms this. No doubt can be implied or suggested as to the training and or comparative skills of podiatric surgeons in Australia.

Hospital Costs
To satisfy the intent of federal parliament when passing the recent 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 accredited podiatrists (podiatric surgeons). Many insurance companies comply with this intent - if your fund however discriminates against podiatric surgeons 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.

Surgical Fees and Anaesthetic Fees (Podiatric Surgery)
It is still the case that no Medicare benefit exists for these services. Under the new legislative arrangements insurance companies have the option of offering an insurance product which covers these fees.

In Australia private health insurance companies are under no obligation to pay for podiatric services but many do and they all have the choice to do so (as is the case for many 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 it's 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
Level 7, 362 Kent Street
Sydney NSW 2000

Complaints Hotline:1800 640 695 (free call anywhere in Australia)
Telephone: (02) 8235 8777
Facsimile: (02) 8235 8778
Email: info@phio.org.au