What Is Worth Flagging on a Statement and What Is Not
Five real world anomalies you can spot in 60 seconds, with the response that usually works.
Rate increases above the published price. A provider's published price for cleaning is $76 an hour, the statement shows $85. A polite query usually fixes this without needing to escalate.
Duplicate visits. Same service, same date, two charges. Almost always a billing error. The provider will refund once it is pointed out.
Stream misclassification. Occupational therapy appearing under Independence rather than Clinical. This costs the participant a higher contribution. Ask why it has been classified that way.
Care management above 10%. The program manual caps care management at 10% of the quarterly allocation. Anything higher than that is not compliant.
Services not in the care plan. A charge for a service that is not in the care plan should never appear. If it does, query it immediately and copy in your care manager.
Always document the response. If the provider does not resolve the issue within 14 days, escalate to OPAN on 1800 700 600 or to the Aged Care Quality and Safety Commission.