Billing Guide
A Baby Steps Guide to Billing – Explained Simply
The Basics (Start Here)
Whether you’re booking a medical or allied health appointment, this guide explains how fees and rebates work at Baby Steps — in plain language.
At Baby Steps:
- Each practitioner is an independent provider who sets their own fees.
- Most services are privately billed, meaning you pay the full fee upfront.
- After your appointment, reception will help you settle your bill. You can pay using EFTPOS, credit card, cash or by bank transfer.
- Depending on the type of service and your eligibility, you may be able to claim money back from Medicare, private health insurance, or NDIS (if applicable).
Medical vs Allied Health – What's the Difference?
- Medical providers include GPs and Paediatricians. These practitioners diagnose, prescribe, and manage medical care.
- Allied health providers offer therapeutic or support services such as physiotherapy, speech pathology, OT & more.
Medical providers at Baby Steps
- General Practitioners
- Developmental and General Paediatricians
Allied Health providers at Baby Steps
- Physiotherapists
- Occupational Therapists
- Speech Pathologists
- Psychologists
- Dietitians
- Lactation Consultants
- Music Therapists
- Sleep Consultants
- Counsellors
Step-by-Step: How Rebates Work
Medicare (Australia’s Public Health Insurance System)
- Medicare helps cover part of the cost for many medical appointments.
- If your appointment is eligible, we will process your Medicare claim at the front desk while you pay.
- The rebate will be deposited into your bank account (usually within 1–3 business days) – check your MyGov account to see which bank account is linked to your Medicare card.
- In most cases, Medicare only covers a portion of the full fee — so there will be an out-of-pocket cost, also called a gap fee.
Private Health Insurance
(Extras Cover)
- If you have extras cover, you may be eligible to claim a portion of allied health services like physiotherapy, occupational therapy, speech therapy, or dietetics.
- At Baby Steps, you can swipe your private health card at reception using HICAPS, which means your rebate is applied instantly, so you only have to pay the remaining gap.
- You don’t need a referral or care plan to claim through private health.
Note: You can’t claim both Medicare and private health for the same appointment.
NDIS (National Disability Insurance Scheme)
The NDIS provides funding for children with disabilities or developmental delays to access therapy and support services.
Who qualifies for NDIS?
Your child may be eligible if they:
- Have a significant and permanent disability (physical, intellectual, sensory, or psychosocial), such as Autism Spectrum Disorder (ASD), Global Developmental Delay (GDD), ADHD, cerebral palsy, or a genetic syndrome
- OR are under age 9 with developmental concerns and require early intervention
You can speak to your GP, Paediatrician, or allied health team for help applying, or contact an NDIS Local Area Coordinator (LAC).
How NDIS affects billing:
- Children with self-managed or plan-managed NDIS funding can access care at Baby Steps.
- However, Baby Steps is not an NDIS-registered provider, so agency-managed patients cannot claim their NDIS benefits here.
NDIS Plan Types Explained
NDIS Plan Types Explained
It’s all about who pays the bills, who can provide services, and how much flexibility you have. Here’s a simple breakdown:
Self-Managed
- You’re in full control.
- You choose your providers (registered or not).
- You pay invoices upfront and claim the money back from the NDIS.
- You handle your own record keeping and budgeting.
- Example: You book a Continence Physio at Baby Steps, pay on the day, and then upload the invoice to the NDIS portal for reimbursement.
Plan-Managed
- A registered plan manager pays your invoices for you.
- You still choose your providers — including non-registered ones like providers at Baby Steps.
- You don’t have to pay upfront.
- Your plan manager takes care of the claiming and paperwork.
- Example: After your child sees a Speech Therapist at Baby Steps, the reception will send the invoice to your plan manager, who pays the bill directly using your NDIS funds.
Agency-Managed (NDIA-Managed)
- The NDIA controls your funding.
- You can only use NDIS-registered providers.
- The NDIA pays those providers directly.
- You don’t handle payments or claims, but you have less flexibility.
- Example: There are no providers at Baby Steps who are NDIS-registered, so you can’t use agency-managed funds to pay for our services unless you change your plan to plan- or self-managed.
Guide to Medical Appointments (GPs & Paediatricians)
Medical appointments at Baby Steps include visits with GPs and Paediatricians. These providers manage your child’s health, development, and medical concerns.
GP Appointments
You do not need a referral.
A Medicare rebate is available for most GP visits.
You will pay at reception after your appointment.
If your Medicare details are linked with MyGov, your rebate is automatically processed and deposited into your bank account within a few days.
Paediatrician Appointments
You need a referral from a GP before your first appointment.
A Medicare rebate applies if the referral is current (valid for 12 months unless otherwise stated).
You pay at reception, and your rebate is processed just like with a GP.
Immunisations
Fully bulk billed, meaning there is no fee to pay.
Guide to Allied Health Appointments
If you’re booking in with a Physiotherapist, OT, Speech Pathologist, Psychologist, Dietitian, or Music Therapist without a GP care plan, here’s how billing works — and how to know if you can claim anything back.
Paying for Your Appointment
These services are privately billed, meaning you’ll pay the full consultation fee at reception after your appointment.
Can I Claim Anything Back?
That depends on whether you have private health insurance:
If you have extras cover:
- You can usually claim a rebate on eligible allied health services.
- Baby Steps has HICAPS at reception — they will ask you to swipe your health fund card and you’ll only pay the gap.
Example: You attend a $130 speech therapy session. If your health fund covers $60, you only pay $70 on the day.
If you don’t have private health:
- You’ll need to pay the full amount.
- You won’t be eligible for any Medicare rebate unless you’ve set up a GP care plan (explained below).
- Some families claim allied health costs at tax time — check with your accountant.
What If I Might Be Eligible for a Medicare Care Plan?
- Allied health services can attract a Medicare rebate — but only if your GP has created a formal care plan.
- You don’t need to decide this alone. If you’re unsure, book a GP appointment first to discuss whether a plan is appropriate.
Key Takeaway: If you don’t have private health or a GP care plan, you’ll pay the full fee. But if you do have one of these, rebates may apply — so it’s worth asking.
If your GP has arranged a care plan, you will be eligible for Medicare rebates for allied health services. There are two main types of care plans.
Chronic Disease Management Plan (CDM)
For people with a medical condition present for at least 6 months — such as asthma, diabetes, ADHD, chronic pain, developmental delay, or postnatal conditions.
Gives you access to up to 5 Medicare-rebated allied health sessions per calendar year.
Mental Health Care Plan (MHCP)
For patients experiencing mental health concerns such as anxiety, depression, behavioural issues, or emotional dysregulation.
Gives you access to up to 10 Medicare-rebated sessions per calendar year with an eligible psychologist, counsellor, or Accredited Mental Health OT.
How It Works
- Book a GP appointment to assess whether a care plan is suitable.
- If eligible, your GP will create the plan and refer you to the appropriate provider.
- You attend your allied health appointment, pay the full fee, and your Medicare rebate is processed at reception.
- Your rebate is automatically deposited into your account by Medicare.
- Once your plan sessions are used, you may:
- Continue privately
- Switch to claiming through private health (if eligible)
- Return to your GP to renew or adjust the care plan.
New to Medicare? How to Get Started
If you’ve just moved to Australia, or recently had a baby, you’ll need to enrol in Medicare before you can access rebates.
For New Parents
If your baby has just been born, you can:
- Add your baby to your Medicare card using the Newborn Child Declaration form (provided at the hospital), or
- Enrol them online via Medicare Services on MyGov.
Once your baby is added, you’ll receive an updated Medicare card in the mail. You’ll then be able to:
- Book GP and paediatrician appointments
- Access immunisations and health checks
- Claim Medicare rebates for eligible services
For New Residents
If you’re new to Australia, you may be eligible for Medicare if you:
- Are an Australian citizen or permanent resident
- Hold a visa covered by a Reciprocal Health Care Agreement, or
- Are applying for permanent residency
To enrol, visit a Medicare Service Centre with identification and visa documents. You’ll receive a Medicare number and eventually a card, allowing you to claim eligible rebates.
Once registered, link your Medicare to your MyGov account to receive automatic rebates into your bank account after eligible appointments.
Cancelations and Rescheduling
- Cancellation policies vary between providers — some require 24–48 hours’ notice or a fee may apply.
- If you need to reschedule, contact reception as early as possible.
- Missed appointments are usually not eligible for Medicare, NDIS, or private health rebates.
- Some NDIS plans have funding for cancellation fees — check with your plan manager.
Invoices and Receipts
After your appointment, reception can provide an itemised receipt or invoice. This is especially useful if:
- You are claiming through a self-managed NDIS plan
- You prefer to submit private health claims manually
- You need documentation for your accountant or tax return
Receipts can be printed on the spot or emailed to you on request.
Keeping Track of Sessions and Rebates
If you’re using a care plan or NDIS funding, it’s a good idea to track your used sessions to avoid running out unexpectedly. Reception can let you know how many appointments have been claimed, but ultimately, tracking usage is your responsibility — especially with NDIS self-managed or plan-managed funds.
You can also view your Medicare claims history by logging into MyGov > Medicare and selecting “Claims History.”
Care Plan Reviews and Renewals
If you have a Chronic Disease Management Plan or Mental Health Care Plan, your GP may need to review and update the plan partway through the year:
- CDM plans can be reviewed annually or as your needs change.
- MHCPs typically include an initial 6 sessions, with a review before the final 4.
Your GP will check in with you (or your child) to ensure the plan is still appropriate and make any adjustments needed.
