Private Fee for Service
About Private Fee for Service
Private fee for service means paying a provider directly, out of pocket, without going through the NDIS, aged care, DVA or another funded scheme. People do this because they do not meet a scheme’s eligibility, to get a service faster than a funded pathway allows, or by choice, for flexibility or privacy.
Providers who accept private fee for service set their own rates and terms with the client, not within a scheme’s price guide. Costs and inclusions can vary a lot, so ask for a clear, itemised quote before starting. None of the eligibility or claims processes of the funded schemes apply.
At a glance
- You pay the provider directly, outside any funded scheme.
- Providers set their own rates and terms.
- Costs vary, so ask for an itemised quote first.
- Scheme rules and claims processes do not apply.
This is general information, not financial or funding advice. Program names, amounts and eligibility rules change over time. Always confirm current detail with the relevant official body before relying on it.
How to prepare before arranging support
- Ask the provider for a clear, itemised quote before starting.
- Ask what is included, because the provider sets its own rates and terms.
- Remember that the eligibility and claims processes of funded schemes do not apply.
Information and records to have ready
- Policy, membership or claim details
- Referral, approval or case-manager correspondence
- Written quote and explanation of likely gaps
- Invoices, receipts and benefit statements
Questions to ask a provider
- Do you bill this scheme directly, or must the person pay and claim?
- Is a referral, approval number or case-manager authority required?
- What is the total fee and likely out-of-pocket amount?
- Are there annual limits, waiting periods, approved-provider rules or session caps?
- What happens if the claim is delayed, reduced or declined?
Common mistakes to avoid
- Assuming a service is covered because it was covered before
- Confusing a rebate with full payment
- Starting before required written approval
- Failing to check annual limits, waiting periods or provider eligibility
Frequently asked questions
Why would someone pay privately?
They may not meet a scheme’s eligibility, may want a service faster than a funded pathway allows, or may prefer the flexibility or privacy.
Who can confirm what Private Fee for Service means for me?
Ask the responsible insurer, scheme or program. A provider can explain its services and billing, but it cannot make a binding funding decision for the responsible body.
Does a provider listing prove it accepts private fee for service?
No. A directory or public-register listing describes a provider and the supports it lists. Confirm the funding arrangement, approval and current availability with the provider before booking.
What if the rules or my circumstances change?
Check the current guidance with the responsible insurer, scheme or program, tell your providers promptly and update written agreements or approvals before relying on the changed arrangement.
Official sources
Other Other Funding topics
Browse providers or explore other funding topics.
Helpful reading
- NDIS jargon explained: the terms you will hear and what they mean: Plans, supports, coordinators, managers, registered providers: a plain-language glossary of the words that come up most often.
- NDIS or My Aged Care: which system supports you?: Two government systems support people with disability and older people. Here is how to think about which one applies and what to do if you are not sure.
- Keeping records of your NDIS supports: a simple system: Good records make plan reviews, claim queries and changes of provider far easier. Here is a light-touch way to keep them.