Health Fund Claiming Infomation

 
 

At Balance, we want claiming your health fund benefits to be simple and transparent. We follow all private health insurer rules and Australian health regulations to make sure your claims are accurate and compliant.

How claiming works

All services are claimed based on:

  • The profession of the practitioner who treated you

  • The provider number of that practitioner

  • The service actually delivered

This means claims cannot be changed, split, or submitted under another practitioner or profession. Health funds regularly audit claims, so submitting accurate information protects you and keeps your benefits safe.

  • Physiotherapy sessions are claimed as physiotherapy

  • Chiropractic sessions are claimed as chiropractic

Our team-based approach to care

We have both physiotherapists and chiropractors available at every clinic every day. This means your care can be co-managed, allowing our team to collaborate and make sure you’re seeing the right practitioner for your needs.

If you reach your annual limit with one provider type (for example, physiotherapy or chiropractic), our team can discuss whether seeing another practitioner might be suitable for your ongoing care — always based on what’s best for your recovery.

All claims will always:

  • Reflect the profession of the practitioner you see

  • Be submitted under the treating practitioner’s provider number

  • Comply fully with health fund rules

 

Frequently Asked Questions

Can I claim my session as chiropractic if I was treated by a physiotherapist?

No. Health funds require claims to match the profession of the treating practitioner. If you were treated by a physiotherapist, the service must be claimed as physiotherapy — regardless of the techniques used.

Can my treatment be claimed under another practitioner’s name?

No. Claims must be processed using the provider number of the practitioner who delivered the treatment. We cannot submit claims under another provider’s name.

Why was my claim rejected?

Claims may be rejected due to:

  • Exceeded annual limits

  • Policy exclusions or waiting periods

  • Incorrect provider type

  • Health fund rules specific to your policy

If this happens, your health fund can provide the most accurate explanation.

What if I’ve used up my physio or chiro benefits?

If you’ve reached your annual limit with one provider type, our team can:

  • Review your care plan

  • Discuss whether another practitioner may be suitable for your ongoing treatment

  • Help you understand how claims would work for future appointments

Any changes to your care will always be based on what’s best for your recovery, while remaining fully compliant with health fund requirements.

Can the clinic make exceptions?

No. Health fund claiming rules are set by insurers and must be followed by all clinics and practitioners.

What if I’m unsure what I can claim?

We recommend checking your level of cover directly with your health fund before your appointment. Our reception team can also confirm which practitioner you are booked with.

Why is this policy important?

Following health fund rules protects:

  • You, from claim issues or repayments

  • Our practitioners, from audits or penalties

  • The clinic, from compliance breaches