PATS frequently asked questions

Here you can find responses to some of the more frequently asked questions regarding PATS.

Am I eligible for PATS?

To make a claim for the PATS subsidy, you need to be:

  • a permanent resident of a WA Country Health Service (WACHS) region
  • travelling more than 100 km one way to access your nearest eligible medical specialist service (including a Telehealth service).
  • you are undergoing cancer or renal treatment and need to travel more than 70km.

You cannot claim the PATS subsidy if:

  • you are travelling to the treatment centre for another reason, such as for a holiday or to visit friends, and then need specialist treatment
  • you are a FIFO worker
  • you are on a bridging visa
  • you are a student at boarding for school or university and need medical treatment while living in the treatment centre (such as Perth). However, a parent may be eligible for escort assistance to visit their child in the treatment centre (for example, if a child is under 18, is in hospital and requires an adult to make decisions)
  • you are eligible for alternate forms of assistance, such as through the Department of Veterans Affairs, workers compensation or other insurance, such as travel insurance.

Are there exceptions to the minimum distance criteria?

Yes. If you need to travel between 70 and 100 kilometres to receive cancer or dialysis treatment, you may be eligible for limited PATS assistance.

Contact your local PATS office for more information.

What is a specialist medical service?

An eligible medical specialist service includes:

  • A medical practitioner who is recognised as a specialist for Medicare Benefits purposes (with the exception of pathology and/ or clinical pharmacology)
  • A hospital or health service-employed medical specialist
  • A specialist medical service or oral surgery item covered by an item in the Medicare Benefits Schedule (MBS) book
  • Specialist services involved in the fitting of an artificial limb
  • Specialist services involved in the fitting of an artificial eye
  • Dental treatment covered by an item in the Medicare Benefits for Services by accredited dental practitioners in the treatment of cleft lip and cleft palate conditions.

PATS assistance is available for four antenatal visits to the nearest GP Obstetrician with each pregnancy. If more antenatal visits are required, the medical practitioner needs to provide supporting medical information.

If you are not sure if the treatment you are seeking is eligible, speak to your local PATS office.

I’m seeing a private specialist. Am I eligible for PATS assistance?

Yes. There is no distinction between public and private specialists for the purposes of PATS. You just need to be going to the closest available specialist service.

If the requirement to see a private specialist causes you significant financial difficulty, talk to your local PATS office. You may be able to travel to a public specialist (even if they are not the closest) through an exceptional ruling. This will only be approved if there are exceptional circumstances.

I want to travel to a different specialist that is further away. Will PATS assist me?

No. PATS only provides a subsidy for travel to the nearest medical specialist. This includes specialist services delivered by telehealth.

Can I travel to see a specialist if there is a similar specialist I can see locally through Telehealth?

No. If the specialty you need is available through telehealth, you are only eligible for PATS for assistance to get to the telehealth appointment.

I’ve been seeing my specialist for years, but now there is a specialist travelling closer to home. Can I still see my original specialist?

You can’t get PATS assistance to travel to your original specialist if there is a closer one, unless there are clinical (medical) reasons for you to do so.

Can I get PATS assistance for a second opinion?

You can only get PATS assistance for a second opinion if the first specialist you see refers you, or there is some clinical (medical) reason it is needed.

What can PATS reimburse me for?

PATS provides a travel and accommodation subsidy to eligible country residents and their approved escorts (people who come with you to your specialist appointment to help you). PATS provides flights for persons living more than 16 hours’ drive from the nearest treatment centre, or in cases of medical necessity requested by the referring or treating practitioner. Please note that while your doctor may request a flight, the PATS office needs to assess the request before it is approved.

PATS does not cover the full cost of travel. It is a subsidy only. It is designed to assist with some out-of-pocket expenses associated with travelling for specialist medical services. You will need to keep your receipts so you can claim for these expenses.

If you are eligible, you can claim a subsidy towards the following:

  • fuel subsidy for private vehicle use
  • surface transport (trains or buses)
  • air travel (conditions apply)
  • accommodation
  • in some circumstances we provide financial assistance towards the cost of having an escort/ carer support you during your treatment.

You cannot claim PATS for ambulance travel.

Are skin cancer clinics covered?

If you are referred by a doctor to a specialist at a skin cancer clinic, you are eligible for PATS. If you are seeing a general practitioner, even one with a special interest in skin cancer, you will not be eligible for PATS.

Does PATS only cover you from the town centre?

Generally, PATS covers your travel from your town centre to the place where your treatment takes place. However, if you live outside the town boundaries, notify your local PATS Office and the extra distance can be added to your reimbursement.

Will PATS pay for taxi vouchers?

Not usually. In limited and exceptional circumstances, they may be provided. For example, if a person is using a wheelchair, is blind or has severe vision impairment, or has an intellectual disability. PATS staff will consider such requests  on a case-by-case basis.

There are a number of bus services that operate from the domestic airport to Perth, including Route 380, which has accessible buses that stop at Belmont Forum and Victoria Park.

Public Transport Options

Are all health treatments covered?

No. PATS helps give you access to specialist medical services only.

What are some examples of health services and health treatments that PATS doesn’t cover?

PATS doesn’t cover:

  • the extraction of third molars (wisdom teeth) – including treatment under general anaesthetic or sedation
  • orthodontic treatment (braces)
  • non-surgical temporo-mandibular joint treatment (also known as the jaw joint)
  • implant surgery or crown and bridge treatment
  • endodontics (root canal therapy)
  • periodontal (gum) surgery or treatment
  • MBS items in the Allied Health and Dental Services book (10975 – 10977)
  • cosmetic surgery
  • complementary health treatments, such as acupuncture or herbal therapy
  • physiotherapy, speech therapy, podiatry, occupational therapy and other allied health treatments.

Also see allied and dental treatment below.

When am I eligible for accommodation assistance?

You are eligible for accommodation assistance only if you live more than 100 km from the treatment centre and:

  • the medical specialist certifies that you need to stay overnight for follow-up
  • the forward and return journeys cannot reasonably be completed in one day because of factors such as:
    • time required travelling
    • type of travel
    • transport schedules and availability, or
    • your medical condition.

If you are required to attend an associated allied health appointment after your specialist appointment, you may be able to extend your stay by one or two days.

If I need to travel by air to my specialist appointment will I have to pay for the flight and then seek reimbursement from PATS or does PATS pay for flights before I travel?

Your local PATS office may be able to book flights for you, but this varies from region to region. Talk with your local PATS office to see what assistance is available in your area.

I need someone to travel with me. Will PATS assist?

You may be eligible for an escort (someone to travel with you to your specialist appointment) if:

a)    the person being escorted is a dependent child

b)    Centrelink has determined that you are under the care of a principal carer

c)    you are a home dialysis patient who is receiving training (a carer is required to attend as a condition of the medical specialist treatment)

d)    the escort is legally required to make decisions on your behalf, and/ or

e)    the referring practitioner, prior to departure specifies the reason why an escort’s presence is essential, on the PATS Application form, based on their assessment that you would be unable to manage their treatment alone, particularly if the applicant is undergoing treatment for cancer or is disabled or frail.

I’ve had a medical emergency, and have been sent to hospital with the Royal Flying Doctor Service (RFDS) or by Inter Hospital Patient Transfer (sent from one hospital to another). Am I eligible for an escort while i'm in hospital?

An escort is usually not required while a person is being treated in hospital, unless there are special circumstances which are requested by the treating specialist. You may be eligible for an escort after you have been discharged if you need assistance to return home.

 

Am I eligible for PATS accommodation assistance after I get out of hospital or after I’ve been taken to hospital in an emergency?

You will be provided with PATS accommodation assistance following discharge after you’ve been admitted to hospital if:

  • you are required to stay at or near the treatment centre for outpatient specialist medical care after discharge from hospital
  • you are returning by air travel and you are unable to fly until medical clearance to fly is provided by the treating medical practitioner. (Note: airlines have guidelines on the period of time a person should not travel by air after serious illness, injury, surgery or hospitalisation. You should check with your doctor that they are satisfied you are able fly)
  • transport schedules do not permit immediate transport home on the day of discharge. This only applies where the earliest available transport of the approved type is utilised
  • you have to remain overnight while in transit (for example, when you are waiting transfer back to a remote community), and/ or
  • you are required to return to the specialist for a follow-up appointment within a short period after discharge from hospital.

What is allied health treatment?

Allied health services include physiotherapy, occupational therapy, speech pathology, clinical psychology, podiatry, dietary and nutrition services, respiratory therapy and other health care services.

Does PATS cover allied health treatments?

Not usually. PATS is designed for access to specialist medical treatment.

If you need allied health treatment associated with specialist treatment, you may be able to receive an extra night or two of accommodation supported by PATS.

Does PATS cover dental treatment?

Most general dental treatments are not covered.

The main dental treatments covered by PATS are:

Dental and Oral Specialists:

  • Specialists treatments covered by Oral and Maxillofacial Medicare Benefits Schedule items, including facial trauma, jaw fractures, serious dentofacial infections and oral malignancy (cancer)

  • Treatment provided under the Cleft Lip and Palate Scheme.

Services for young Children under (8) years of age:

  • urgent and critical dental treatment requiring general anaesthesia. This includes removal of tongue tie for a newborn baby by a specialist paediatric dentists in cases where the child is not thriving.

Services for children:

  • Hospital-based management of severe dental trauma or severe dentofacial infections, such as cellulitis

  • Hospital-based dental services for children with significant medical co-morbidity or other serious conditions

Services for Adults:

  • Hospital-based dental services for adults with significant medical co-morbidity or other serious conditions

  • Dental treatment for adults with special needs requiring general anaesthesia

 Contact your local PATS office for further information on dental treatments covered under PATS. 

I don’t quite fit the criteria for PATS but I still need financial assistance – what should I do?

If you are not eligible for PATS but you still meet the intent of the scheme – that is, you are a country resident who needs to travel for specialist treatment – you may have your application approved as an Exceptional Ruling.

An Exceptional Ruling is made by the Regional Director. You need to provide as much supporting information as you can to support your claim. This may include letters from your doctor or other specialist, copies of appointments letters, information from Centrelink, or anything else that may help the Regional Director make a decision. Every Exceptional Ruling is made on its merits, and does not form a precedent for future decisions.

I live in the Peel region. Can I get PATS?

Peel is not part of the WA Country Health Service. However, some residents of the Peel region have access to PATS and should contact Peel PATS on 95864413 or PATS.Peel@health.wa.gov.au.

How do I make a PATS claim?

You need to apply for PATS before you travel for treatment. That way you know you are eligible for PATS assistance. You then claim for your expenses after you have been to your specialist appointment.

  1. You need a PATS Application Form which is available online or by contacting your local PATS office.  Your GP may also have forms available.
  2. Your GP or medical practitioner needs to fill out the referral details in Part A. You complete all your personal details in Part B. Provide the completed form to your local PATS office.
  3. You need to get the specialist or specialist clinic to fill out the PATS Specialist Certification Form and submit that to your local PATS office within eight weeks after your specialist appointment. You will need to attach receipts to receive reimbursement.

If you are in the South West, the process is different.

  1. Ask your GP to phone or fax the PATS office to register your claim.
  2. Contact the SW PATS office on 1800 823 131 to complete your registration prior to your appointment.
  3. If approved, you will  receive a PATS Specialist Certification form to take to the specialist.
  4. The specialist will sign this form to confirm your attendance and any further necessary appointments.
  5. Post, fax, email or take the PATS Specialist Certification form to your South West PATS office within eight weeks or your appointment and ensure all necessary receipts are attached.
  6. Payment of any assistance you are entitled to will then be posted (Cheque) or paid by EFT.

South West PATS can be contacted on:

Phone: 1800 823 131 (Monday to Friday 8:30am to 4:30pm)  
Fax: 08 9427 9011    
Email:swpats@medibankhealth.com.au                                                                                                                                                          

Postal: South West PATS Office
PO Box 712
Osborne Park BC WA 6916

How do I get reimbursed for my accommodation and travel expenses?

You need to get your specialist or specialist clinic staff to complete the PATS Specialist Certification form (after you’ve completed your PATS application form), and return it to your local PATS office after the appointment date. You will then be reimbursed for your out-of-pocket expenses.

Ask your local PATS office how long it will take to receive your reimbursement.

How much will I get reimbursed?

PATS is a subsidy only, and will not cover all your expenses.

The accommodation subsidy is:

  • Private home accommodation $20 per night for an eligible applicant or $40 per night for an applicant travelling with an approved escort
  • Commercial accommodation (taxation receipts are required) Up to $60 per night for an eligible applicant or up to $75 per night for an eligible applicant travelling with an approved escort.

The fuel subsidy is 16 cents per kilometre for a private vehicle.

If two or more applicants are travelling in a minibus, or similar group transport vehicle, owned by a community or organisation, the fuel subsidy is 25 cents per kilometre, per vehicle payable to the organisation.

People travelling by coach or rail are eligible for the relevant economy or discounted fare.

Applicants accessing cancer or dialysis treatment who are required to travel between 70 and 100 kilometres are eligible for $20 subsidy.

Contact your local PATS office for more information.

How long will it take to process my claim?

The time it takes to process a claim varies but payment should be made within 30 days from the date we receive your claim, subject to the correct information and necessary documents (such as your taxation receipts) being received by your local PATS Office.

What forms do I need?

To submit a claim you will need PATS Application Forms. These are available from your local PATS office or online.

The PATS Forms include:

  • PATS Application Form (Section A) and (Section B)
  • Specialist Certification Form

When do I need a PATS Application form?

If it is the first visit to a specialist or if your circumstances change, you are required to complete a PATS Application form.

How long is my PATS Application form valid?

Your PATS Application is valid for 12 months from the time your referring doctor signs the form. If you visit a new specialist for an unrelated medical condition, a new PATS Application form is required. If your circumstances change and you now require an escort, ask your treating GP or specialist to note this on the PATS Application or PATS Certification Forms.

This isn't the first visit to my specialist, so when do I need to complete a new PATS Application form?

You don't need a new form until 12 months after your initial appointment date.

After 12 months, you will be required to submit a new PATS Application Form.

How do I contact my local office?

Contact your local PATS office.

If I want to provide feedback on PATS, how do I do this?

  1. Contact your local health service or PATS office: they will provide you with information on how to give feedback directly to the health service. The health service has to record and respond to all feedback that is received.
  2. If you would like advocacy and support with the complaint process you can contact the Health Consumers' Council on 1800 620 780 or visit hconc.org.au. The Health Consumers' Council is an independent community-based organisation that represents health consumers.
  3. The Health and Disability Services Complaints Office can also help you resolve any complaints you may have. Their website is at hadsco.wa.gov.au or free call 1800 081 583.

I’ve had my application declined. Can I get a review of a PATS decision?

Yes, you can.

You need to write down the reasons why you think there should be a review, including any extra information.

Send a copy of this to the PATS Regional Coordinator of the health services where the initial decision was made.

The PATS Regional Coordinator will consider your complaint or review request against the PATS policy, including the Exceptional Ruling policy.

You may be contacted to provide other information.

The PATS Regional Coordinator will write to you about the outcome of your review within 30 days, or sooner if the matter is urgent.

If you have raised your concerns with the PATS Regional Coordinator and you are still not satisfied, you can ask for a further review of the decision by: