In 2015, the federal government budget imposed major changes in Medicare funding for optometry. There was a 5% cut in the Medicare schedule fee rebate for optometric services, despite our fees having increased at a rate below CPI since the late 1990s, and not increasing at all since 2012. These cuts put the government rebate well below the true cost of providing quality eye care.
Furthermore, your eligibility for optometry services has been changed. Previously a patient without symptoms was eligible for a full comprehensive eye examination once every two years. Since the budget changed, patients aged 65 years and over are eligible for this same service every year, but patients younger than 65 are only eligible every three years. This change, although positive for those over 65 years, does not align with evidence-based practice for ensuring the best eye health across patient demographics.
It is important to note that this timeframe is for asymptomatic patients, and that if you are experiencing any symptoms you should present to your optometrist promptly as different rebates may apply.
Our New System – Easyclaim
As of February 2019 Optikus is implementing a new payment system called EasyClaim. You may be familiar with this system from your other health care providers in which your medicare rebate is claimed for you at the time of your consult and is then paid back to your nominated bank account within 1 business day.
What Is My Medicare Rebate
Medicare entitles you to a rebate of between $28.45 and $56.80 for a standard optometry consultation depending on which items you are eligible to claim on the date of your consultation. Ocular imaging is not eligible for a Medicare rebate, however, specialised optometric consultations, for example; contact lens fitting, paediatrics, low vision assessment, myopia control and foreign body removal; are eligible for a medicare rebate, the amount of which is case dependent and will be discussed with you prior to your consultation.
Is There A Gap
Yes. Unfortunately, due to the cuts in Medicare billing, we are unable to sustain bulk billed appointments. The following professional fee schedule outlines our standard consultation fees, part of which will be covered by your medicare rebate. By incorporating ocular imaging into our standard consultations, we aim to keep the change in fees as minimal as possible, for most patients this equates to approximately a $14 difference compared to our previous billing structure.
Optometrist Consultation Gap Payment
Standard Consultation – $100 $43.20
New Adult Consultation – $135 (Includes OCT) $78.20
New Child Consultation – $110 $25
Concession Card Discount – 5%
Ocular Imaging – Please note all imaging except OCT scans are included in a standard consult at no extra charge.
Digital Retinal Imaging – $30
Optical Coherence Tomography (OCT) – $56
Anterior Eye Imaging – $30
Corneal Topography – $30
To be able to provide you with the best possible care for your vision and health using cutting edge diagnostic technology in all consultations for all age groups.