How we pay for treatments and services
There are two ways we can pay for your approved treatments and services:
- we pay your provider at the TAC rate
- you pay your provider, and we repay you at the TAC rate.
To ask for a reimbursement, scan or take a photo of your receipt and send it to us:
- Via the myTAC portal or app. Go to upload documents > reimbursement form and send us a photo of your receipt or proof of payment and a description of what you've paid for
- If you can't use myTAC to send us your receipts, please take a photo and email it to email@example.com. Include your claim number in the subject line of your email so we can process your request.
What is the TAC rate?
By law, the TAC must pay for treatment and services at a rate that we determine is reasonable. We publish these rates on our website.
This is in line with our responsibilities under the Transport Accident Act 1986.
What is a 'gap payment'?
In most cases, we will pay your provider at the TAC rate. If your provider charges more than this, they may ask you to pay the difference. This is known as a ‘gap payment’.
You should talk to your provider about their rates before you attend your first appointment. Questions you can ask are:
- Do you charge at the TAC rate?
- Will there be a gap that I need to pay?
- Do you charge the TAC for my treatment or service, or do I need to pay in full?
If your provider charges you a gap payment, you may be able to seek reimbursement for some of this through:
- Medicare or your private health insurance
- The TAC.
Please note, in most cases, we are unable to reimburse you for a gap payment. This is because we have paid for your treatment or service at a rate we have determined is reasonable. You may still ask for a reimbursement from the TAC and we will let you know our decision.
Reasons we might not pay for a treatment or service
The reasons include (but are not limited to):
- We need to approve the treatment or service before we can pay for it
- The TAC is unable to pay for that type of treatment or service
- The TAC has already paid for that treatment or service at the rate we have determined is reasonable
- We need more information from you or your provider (see below)
- You have not reached your medical excess (see below)
- We have already made a decision about paying for the treatment or service. If we make a decision to deny, reduce or stop paying for a treatment or service, we will always write to let you know our decision.
We will always let you or your provider know the reason why we can't pay for something.
If we can't pay for a treatment or service, you can still access it and pay for it yourself. We can reimburse you at the TAC rate if we decide to approve the treatment or service later on.
If we need more information
If you or your provider have received a message on your remittance advice that says ‘More information needed to consider this service’, find out what information we need.
If medical excess applies to you
For accidents that happened before 14 February 2018, we can only pay for some non-hospital treatments and services once the medical excess has been reached. Find out if the medical excess applies to you.
If you disagree with a TAC decision
TAC clients have several options if they disagree with a TAC decision. You can learn more about our review process here.