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In reply: What Carroll says is correct, but Section 3.6 of the general explanatory notes of the Medicare benefits schedule book also states that "The only exception to this is where a person has entered into a reimbursement arrangement with a compensation insurer. In such cases a Medicare benefit is not payable".1
While it may be arguable as to what actually constitutes a reimbursement arrangement, the situation is further clarified by Section 13.2.1 of the same schedule, which states:
"Medicare benefits are not payable in respect of a professional service in the following circumstance:
(b) where the medical expenses for the services are in relation to a compensable injury or illness for which the patient's insurer or compensation payer has accepted liability. However, if medical expenses relate to a compensable injury or illness and the insurer or compensation payer is disputing liability, Medicare benefits are payable until liability is accepted".
WorkCover Corporation, Adelaide, SA.
Ian D Steven, Medical Consultant.Repatriation Hospital, Daw Park, SA.
Michael Shanahan, Occupational Physician and Rheumatologist, and NHMRC Research Scholar.Correspondence: Dr Ian D Steven, WorkCover Corporation, Adelaide, SA. IstevenATworkcover.com
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©The Medical Journal of Australia 2002 www.mja.com.au PRINT ISSN: 0025-729X ONLINE ISSN: 1326-5377