How do I claim OT on private health insurance?

Before booking, confirm three things with your private health insurer: (1) whether your current extras cover includes allied health services, (2) your annual limit and any waiting periods, and (3) whether the occupational therapist is registered with AHPRA (Australian Health Practitioner Regulation Agency). Most private insurers require therapists to hold current AHPRA registration to be eligible for claims.

When you see an occupational therapist, ask them to provide an invoice with the correct item code and their provider details. You'll then submit this to your insurer—most now allow online claims through their apps or websites. Reimbursement typically takes 5–10 business days.

Annual limits vary significantly between funds. For example, some cover $500 per year for all allied health combined (including OT, physiotherapy, and speech pathology), while others offer $1,500 or more. Check whether your limit resets on your policy anniversary or calendar year.

If your child is eligible for the National Disability Insurance Scheme (NDIS), you may access OT through your plan instead of private insurance. NDIS-funded OT is typically free at point of service. If you're unsure whether your child qualifies, contact the NDIS or speak with your GP or paediatrician.

For diagnosis or concerns about your child's development, speak with your GP or paediatrician first—they can provide referrals and help determine whether OT is appropriate. If you're experiencing long wait times for public services, contact your state health department or local community health centre for alternatives.