Medicare
Can I get a Medicare Rebate for my Headache Treatment?
Our headache clinicians work as part of the multidisciplinary team of Allied Health Professionals that keep you healthy. Because of that, there are ways that you can access funding for your treatment through Medicare.
Unfortunately, it’s not as simple as just swiping your Medicare care for each session. You will need to ask your GP to create a Chronic Disease Management (CDM) plan, formally known as an Enhanced Primary Care (EPC) plan. This CDM plan will have to include a physiotherapy referral specifically to our clinic in order for your sessions with us to receive a rebate.
Talk to your headache clinician in your initial consultation, and they will be able to give you all the information you need to discuss your CDM plan with your GP. Your clinician can even contact your GP directly to help organise your referral.
Do I have to meet certain requirements?
In short, is yes.
You will require a Team Care Arrangement (TCA) to be arranged by your GP as part of your CDM. Your GP will decide whether you qualify for this or not.
A TCA is intended for people who suffer from chronic conditions. That is, that you have suffered from the condition for longer than 6 months, or you are likely to suffer from this condition for longer that 6 months.
Your TCA will need to involve at least 3 health professionals. This means that at least one other provider must be included in the arrangement, outside of your GP and your headache clinician. TCA’s are able to be used with any allied health service, such as; podiatry, dieticians and exercise physiologists.
Finally, your GP will need to create a referral that is addressed directly to our clinic, in order for you to be eligible to receive your Medicare rebate.
How many treatment sessions are covered by the Medicare rebate?
With your CDM plan, you are entitled to receive up to 5 rebates per calendar year (1 January – 31 December). These rebates are to cover all allied health referrals. The CDM is open to; physiotherapy, dietetics, podiatry, exercise physiology, speech pathology etc. and your GP may refer you for 3 physiotherapy sessions and 2 exercise physiology sessions, for example.
Your rebates will reset in the new calendar year, but you will have to receive a new referral each year.
How much does the Medicare rebate cover?
Currently, the Medicare rebate is set at $58.30 per consult, and this is standard across all services that you receive at our clinic. This means that the price is the same for an initial consult and any subsequent treatments. Unfortunately, we are not able to bulk bill Medicare at our clinic, so there will be a gap payment to make in order to cover the full cost.
How do I claim the Medicare rebate?
Once your CDM/TCA has been approved by all members of your health team, you will be eligible to claim your rebate.
We will charge you the full amount for your session when you are in clinic. Once we have received payment for your session, we can process the Medicare rebate using you Medicare card. This amount can be deposited right back into your account, providing your debit card is attached to either a cheque or savings account. Unfortunately, we are unable to process your rebate using a credit card.
This is the process:
- Pay the full fee for your session
- We will access your rebate by swiping your Medicare card
- We will then swipe your debit card again, and you will receive this rebate back into your cheque or savings account.
Alternatively, we can provide you with a receipt for your transaction, and you are able to claim your rebate through the Medicare website.
SUMMARY
To wrap it all together:
- Yes, you can get a Medicare rebate for your headache treatment, using the CDM Program
- To be eligible you doctor needs to provide you with a specific referral, and your condition will be considered chronic
- You can get $58.30 rebate for up to 5 visits per year
- Once you have payed the full amount for the services that you received, we will use your Medicare and debit card to return the $58.30 rebate to you.
If you have any questions about the Medicare CDM process, feel free to Contact Us our friendly team to discuss the process with them. Further information regarding your CDM/ TCA can be found on the Department of Health website.
Otherwise, come in and see us and we can assist you by liaising with your GP to get the process started and get on top of your headaches and migraines!
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Phase 1
Accurately diagnose your condition for effective treatment
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Phase 2
Experience the latest treatment methods that are evidence-based
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Phase 3
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The Difference
Phase 4
A medication-free solution that treats the cause not the symptons
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What are Cluster Headaches?
Cluster Headaches are a rare type of headaches that affect around 0.1% of the population, according to the International Headache Society. While they are rare, it does affect males 3-4 times more frequently than females [1].
Despite being uncommon, Cluster Headaches are regarded as being the most severe and debilitating type of headache. Research has shown Cluster Headaches frequently described as having the highest pain levels [2], out of all 300 different types of headache and migraine. Cluster Headache attacks occur in cycles, and will often wake sufferers during the night, or at regular times during the day. Attacks generally last between 15-180 minutes, and can happen multiple times per day, or once every couple of days [1, 2]. People who suffer from Cluster Headaches generally experience periods of attacks, or “cluster periods” that can last weeks or months. These periods are then followed by periods of remission lasting weeks, months or even years. The pain is often severe, on one-side of the head, and generally around the eye and/or temple region. Cluster Headaches have adopted the nickname, ‘suicide headaches’ due to their severe and debilitating nature [2].
What are the signs and symptoms?
Cluster Headaches are often severe enough that a sufferer cannot keep still during an attack. They may pace back and forth, have to take a shower, or even resort to banging their head in an attempt to reduce the pan.
Symptoms commonly associated with Cluster Headaches include [2]:
- Severe pain around one eye, that can radiate further around the face or neck
- Restlessness, shortness of breath and/or a sweaty face
- Watery/teary eyes or eye redness
- Swollen or droopy eyelids
- Runny or congested nose
- Pale or flushed skin
- Pain is unilateral, or affects only one side
What are the different types of Cluster Headache?
There are 2 types of cluster headache.
Episodic Cluster Headache
Cluster Headaches most commonly occur episodically. This is when sufferers experience bouts of “cluster periods” that can last for weeks or months, followed by an extended period in remission that can last up to years. They can occur seasonally or at set times each year. Episodic Cluster Headaches account for up to 80% of all Cluster Headaches [1, 2].
Chronic Cluster Headache
When Cluster Headaches occur without a prolonged period of remission, they are termed a Chronic Cluster headache. Sufferers often have “cluster periods” that will last over a year. While they may have days without attacks, the remissions will not last longer than a month.
What are the risk factors?
- Men are 5-6 times more likely to experience cluster headaches
- Sufferers are generally heavy smokers
- Higher alcohol consumption may be a factor
- Cluster Headaches most commonly affect people aged 20-50, but can occur at any age
- People with family members who are sufferers may be at a higher risk
What causes Cluster Headaches?
Historically, it was believed that cluster headaches, as well as migraines, were caused by the dilation of blood vessels in the head, causing pain. This was thought because medications, like triptans, are effective at relieving the pain if taking early enough in an attack. It was believed that triptans prevent this vessel dilation. However, recent research has shown that Cluster Headache and migraine sufferers do not experience blood vessel dilation at any different levels to people who do not suffer. So, how do these medications work?
Modern research has shown that Cluster Headaches and migraines arise from increased sensitivity in the central nervous system [2], more specifically, a sensitised brainstem which is located in the upper cervical spine (the upper neck). Faults in the upper neck can lead to this sensitised brainstem, which then can refer severe pain and associated symptoms into the head and face [3]. Triptan medication has also more recently been shown to de-sensitise the brainstem [4], as well as its original purpose of constricting blood vessels in the head. This would explain why they work, as well as identifying a sensitised brainstem and the cervical spine as a cause of cluster headaches.
I've tried it all, is there anything that can help me?
While Cluster Headaches are very uncommon, they are still experienced in the Gold Coast region. The severity of symptoms causes sufferers to try a range of therapies in an attempt to resolve them, with mixed results. Often, they have tried; medications, injection therapy, or even surgical interventions such as, nerve blocks or blood vessel cauterisation.
At The Headache and Migraine Clinic, we aim to use the most modern research to find the root cause of your cluster headaches. If we can determine that a sensitised brainstem is the cause of your headaches, then we can use world-leading treatment techniques to address the faults in your neck and de-sensitise the brainstem. We have seen plenty of Cluster Headache sufferers at our clinics, and have an 85-90% success rate with our treatment technique. The best part is that it is safe, non-invasive and medication-free.
