There are many private health funds in Australia under the Private Health Insurance Act of 2007 but the question of whether they cover an oxygen concentrator used by a customer is not always clear unless you contact the company directly or visit their website.
It is recommended to contact your health fund personnel. A refund is probably depending on the fund covered clauses. Usually, a refund is effective on medical equipment and mobility aids only if it is linked to your type and level of insurance cover and ultimately depend on your years covered by the fund. Most of the other refunds are part of the hospital package and these are often included under the extras component.
Many benefits are provided by various private health funds which include “Wellness” or “health support” programs, where the customer is able to get special training in how to manage COPD.
Although many funds provide assistance for the purchase of an oxygen concentrator, expecting a rebate from the health funds is very unlikely.
The most common reason for non-coverage of the oxygen concentrator is due to it being regarded as a luxury item despite the fact that it enhances the lives of COPD patients.
Special cases of coverage
In some special cases, the fund covers rental of oxygen equipment and accessories depending on the patient meeting certain conditions.
- Clinically diagnosed with severe lung disease.
- Regular depleted oxygen levels.
- Arterial blood gas levels are within a certain range.
- No other alternative treatments.
If the above conditions are diagnosed, Medicare will pay for part of some expenses.
- Oxygen delivery systems
- Oxygen storage containers
- Tubing and other oxygen-related supplies
- Humidifiers required to bed used with oxygen device in some cases.
How to apply
Once a person is diagnosed that an oxygen device is required, the doctor will issue a detailed written order which will include:
- Patient’s name
- Detailed list of patient’s requirement such as oxygen delivery, flow rates, continuous or pulse requirements and period of use.
- Doctor’s signature and date.
- Commencement date of order.
Medical Insurance Companies that pay Partial Rebate
- Bupa Australia Limited
- GMF Health
- People Care Health Insurance
Medicare used to pay a partial payment for all oxygen equipment but in the past few years, the payment has reduced. In 2013 payment for portable oxygen concentrators was reduced by 50%. This has been the reason for non-coverage of insurance on POC by many insurance companies. However, if a person is qualified to use a POC permanently a reduced rental fee is offered by some insurance providers.
Replacements such as cannulas, masks, tubing and new filters of oxygen concentrators are also usually covered by insurance once the patient has gone through the proper medical tests and documented with medical records.