Working with ACC

Working with ACC

For more information about entitlements, injury support or getting help with an ACC claim, please visit the ACC website.

ACC Claims

New ACC injury claims can be completed by your physiotherapist at the time of your visit, and are submitted electronically to ACC. ACC will advise you of their decision generally within 1-2 weeks. Please note that claim acceptance by ACC is not guaranteed, and where the claim is declined, private treatment fees will apply.

Why do we charge surcharges for ACC visits?

ACC only pays physiotherapists a small portion of the full cost of treatment, therefore a surcharge is required to cover the shortfall paid from ACC.  Surcharges may vary according to clinic location and the qualifications and expertise of the physiotherapist.

ACC Claims and Physiotherapy Treatment

There are some features of ACC regulations that are unique to physiotherapists that can make understanding ACC funding for physiotherapy treatment confusing.  For other medical professionals, there are no treatment limits, or expiry dates for ACC claims.  However, ACC impose restrictions on physiotherapists treating ACC clients under Regulation Fees as follows:

  • Only 16 treatments are allocated per claim in total (regardless of where or with whom these treatments are received)
  • A 12-month expiry date on physiotherapy cover. This means that if your claim is more than 12 months old, the claim may no longer be valid for physiotherapy treatment (although it is still valid for other medical providers).

Under some circumstances we can apply to ACC for more treatments. See “ACC32 processes” below. If you have questions about these physiotherapy-specific regulations, please get in touch with ACC.

Applying to ACC for More Treatment (ACC32 Report)

In some cases it is possible to request additional treatments from ACC if the 16 treatments have been used, or if the 12 month period has expired.  Submitting an ACC32 involves your physiotherapist completing a lengthy report, including collating and attaching all your medical information (including clinical notes, radiology reports, specialist reports etc). Because of the work involved in completing these requests, a report fee applies for all ACC32 requests.

It currently takes ACC up to 4 weeks + to make a decision on these requests and there is no guarantee they will accept the request. During this time you may continue treatment if you wish, however if ACC eventually decline the claim, the balance of payment for any treatments you have had while awaiting the decision will be charged at the private rate.

 

Frequently Asked Questions

We can get information from ACC about how many treatments you have left for your injury, however there may be delays on the ACC provider helpline to get this information, and we may not be able to tell you on your first visit whether you have ACC funded treatments left.  If you pay the ACC surcharge on your first visit but find out the claim has expired or all treatments have been used, a balance of payment to the private fee will be required.

If ACC decline the claim, any physiotherapy treatments received after the date the claim was declined will require the balance of private fees to be paid (see below).

Where there is no current ACC claim, or physiotherapy cover has expired, the full cost of treatment is paid by the patient.  If you have an ACC claim that has been declined, expired, and/or an ACC32 request has been declined, you can still continue treatment at the private rate.

If your medical insurance policy covers physiotherapy then you can claim back the ACC surcharge payments, and the private fees payments (up to the annual limit specified on your policy). A full receipt will be given that will suffice for insurance purposes. Check your policy, or contact your insurance company to find out what is included in your physiotherapy cover.

Medical insurance generally won’t reimburse the cost of materials, report fees, or failed appointment fees. Check your policy for details.

This will depend on the arrangement with the third party.  Some third-parties pay the full cost of treatment (ACC subsidy and the surcharge) and some only pay the ACC subsidy meaning the surcharge is paid by the patient. Get your work representative/case manager to contact us directly about this. 

The arrangement with WINZ varies.  Usually WINZ pay the patient and it is the patient’s responsibility to pay the physiotherapy surcharge directly. Get your case worker to contact us directly to discuss this.

It is important to know that third-party organisations DO NOT pay for the following items. The following costs are the responsibility of the patient:

  • Materials (exercise equipment/theraband etc)
  • Equipment (braces, slings, crutches etc)
  • Failed appointment fees (failure to arrive for an appointment or late cancellation).