ATMS & Health Funds

It is worth recapping that ATMS is a ‘professional organisation’ within the meaning of section 10 of the Private Health Insurance (Accreditation) Rules 2011. This allows ATMS to enter agreements with the health funds on behalf of ATMS Accredited Members, whereby ATMS Accredited Members may be recognised by a health fund. If an ATMS Accredited Member is recognised by a health fund, the provision of benefits/rebates for natural medicine services may then be provided to your client who holds a policy with that health fund.

Gaining Health Fund recognition creates a valuable commercial relationship. Underpinning this valuable commercial relationship is a detailed legal agreement between the health fund, ATMS, Accredited Members and clients. A legal agreement is entered into between ATMS and each different health fund – and each agreement can and does have different requirements and different benefits. Under the agreements ATMS has entered, ATMS is responsible on behalf of all members to assess and maintain compliance with the particular requirements of the health fund.

Where each health fund has different requirements, this requires precise information and assessment by ATMS.

As a consequence Accredited Membership with ATMS may no longer automatically qualify a practitioner to be a recognised provider with a health fund. In particular, recent changes by individual health funds mean that qualification courses done substantially by distance education, or obtained overseas, may no longer be accepted for health fund recognition. Each practitioner must be individually assessed for each health fund based on the current requirements of each health fund.

To manage this complex relationship with Health Funds, the ATMS Board established a Health Fund Working Party in April 2016. Charles Wurf, CEO, will meet with health funds represented by Private Healthcare Australia in Canberra in June 2016.