Psychology and Medicare or Health Fund Rebates
There are eight easy steps to claiming medicare benefits on psychology sessions:
Step 1. Decide you need to see a psychologist.
You have been feeling bad, sad, mad or really stressed out for long enough and you decide you want to get some help. OR maybe your doctor, a friend or another health professional has suggested you "see someone".
Step 2. Decide if you want to use medicare.
You decide the "someone" you see will be a registered psychologist who is eligible to provide medicare funded sessions, and either ...
a. You want to be able to get medicare rebates for your sessions* or
b. You don't want to use medicare rebates (scroll down to private health fund information).
*Access to medicare rebates is through the "Better access to mental health care" initiative of the Department of Health see more at http://www.health.gov.au/internet/main/publishing.nsf/content/mental-ba-fact-pat
Medicare option:
You will need a referral letter that relates to a "Mental Health Care Plan" MHCP.
Step 3. Decide who will issue your referral
You can get the referral from a
Step 4. Book an appointment to get the referral
You will need to book a double session with the GP, as the mental health care plan takes a little longer than the standard consultation. Just tell the receptionist you need to get a MHCP (Mental Health Care Plan) when you book in. They will know exactly what you are talking about, as this is a very common appointment.
Step 5. Attend the referral appointment for assessment
Visit your GP. Ideally, the referrer is your regular GP who knows you well enough and knows that you are experiencing difficulty. If not, that is ok; some people prefer not to see their family doctor for referral to a psychologist. If this describes you, then the next best option is to see a different doctor at your usual practice.
The doctor will want to know what you are feeling and will have a checklist of questions they need to go through; they may also get you to do a short questionnaire. You don't need to tell your doctor all the details of your situation--save that for your psychologist :) All your doctor needs to know is that you have symptoms and are experiencing distress. They have to be able to put you in a category of a mental disorder. However, you don't have to be mentally ill, suffering greatly or at the point of giving up. The whole idea is that you get help before you feel that bad. The most common referrals are for depression or anxiety, and trust me, a lot of people have this, so it is nothing to be ashamed of.
Step 6. Take the referral letter to your psychologist on or before the first session you want to claim
You will leave your doctor's office with a letter and copy of the MHCP. You only need to give the letter to your psychologist; however, they might need to see the MHCP to know what the doctor has recommended.
Step 6b. Enjoy the relief of talking to your psychologist
You have been feeling bad, sad, mad or really stressed out for long enough and you decide you want to get some help. OR maybe your doctor, a friend or another health professional has suggested you "see someone".
Step 2. Decide if you want to use medicare.
You decide the "someone" you see will be a registered psychologist who is eligible to provide medicare funded sessions, and either ...
a. You want to be able to get medicare rebates for your sessions* or
b. You don't want to use medicare rebates (scroll down to private health fund information).
*Access to medicare rebates is through the "Better access to mental health care" initiative of the Department of Health see more at http://www.health.gov.au/internet/main/publishing.nsf/content/mental-ba-fact-pat
Medicare option:
You will need a referral letter that relates to a "Mental Health Care Plan" MHCP.
Step 3. Decide who will issue your referral
You can get the referral from a
- General Practitioner/Local Doctor
- Paediatrician
- Psychiatrist
Step 4. Book an appointment to get the referral
You will need to book a double session with the GP, as the mental health care plan takes a little longer than the standard consultation. Just tell the receptionist you need to get a MHCP (Mental Health Care Plan) when you book in. They will know exactly what you are talking about, as this is a very common appointment.
Step 5. Attend the referral appointment for assessment
Visit your GP. Ideally, the referrer is your regular GP who knows you well enough and knows that you are experiencing difficulty. If not, that is ok; some people prefer not to see their family doctor for referral to a psychologist. If this describes you, then the next best option is to see a different doctor at your usual practice.
The doctor will want to know what you are feeling and will have a checklist of questions they need to go through; they may also get you to do a short questionnaire. You don't need to tell your doctor all the details of your situation--save that for your psychologist :) All your doctor needs to know is that you have symptoms and are experiencing distress. They have to be able to put you in a category of a mental disorder. However, you don't have to be mentally ill, suffering greatly or at the point of giving up. The whole idea is that you get help before you feel that bad. The most common referrals are for depression or anxiety, and trust me, a lot of people have this, so it is nothing to be ashamed of.
Step 6. Take the referral letter to your psychologist on or before the first session you want to claim
You will leave your doctor's office with a letter and copy of the MHCP. You only need to give the letter to your psychologist; however, they might need to see the MHCP to know what the doctor has recommended.
Step 6b. Enjoy the relief of talking to your psychologist
Step 7. Pay the psychologist and get the rebate
Like most doctors, most psychologists also charge more than the medicare rebate, so you will have a 'gap' payment. To get your medicare rebate you will either:
Like most doctors, most psychologists also charge more than the medicare rebate, so you will have a 'gap' payment. To get your medicare rebate you will either:
- Present your referral letter to the psychologist and pay the full fee, after which the psychologist will give you a receipt with details necessary to lodge with medicare.
- Alternately, your psychologist might have an Eftpos machine or software that processes the claim for you. In this instance, you will pay the full fee but the rebate will be processed into your account immediately.
- Get the App! Medicare now wants people to do their claims via app. So once you have your receipt, log on and you can instantly apply for your refund http://www.humanservices.gov.au/customer/services/express-plus-mobile-apps#a3
Focused psychological strategies for +50 minutes is medicare (MBS) item number 80110 and attracts a rebate of $84.80.
Clarissa's fee is currently set at $175 which means you pay only $90.20 out of pocket and will receive $84.80 back from medicare.
Step 8. Attend sessions until needed or until your session limit is reached, then review.
Your referral lasts one year from the date you received it and the MHCP was done. So, if you saw your doctor on 3 October 2017, your referral lasts until 2 October 2018. You are eligible for up to 10 visits/rebates per calendar year for individual sessions and another 10 for group sessions (see rebate form above). However, your initial referral will be for 6 sessions; after 6 sessions your psychologist will need to let your doctor know how you are going and if you need the other 4. Then your doctor will lodge a review item number (you don't necessarily have to go in for another GP session for them to do this) and your plan will be active for another 4 rebates.
Your referral lasts a year, but your sessions 'reset' at the end of the year. So each year you can access 10 sessions.
Example 1. Dianna was experiencing significant depression following her divorce and the death of her mother. She got her MHCP on 3 October and saw her psychologist every week until December 14, totalling 10 sessions (6 plus a review where she was issued another 4). On the 1 of January her eligible sessions for the year reset to 10 again. She didn't need to see her GP as her referral was still valid, so she began seeing her psychologist again in January and continued seeing her for another 6 sessions. She was feeling much better but still needed some support. Her GP approved an additional 4 sessions, which she spread out over the next few months. Dianna's annual allowance of 10 sessions was used up by May. She was doing very well but wanted to have a check-in appointment with her psychologist every month or so. However, her medicare rebates for the calendar year were all used up (for individual sessions) so she began using her health fund cover to supplement the cost of her ongoing sessions.
Example 2. Dianna used all her 10 sessions before Christmas. The next year her sessions reset, but she felt she only needed to see her psychologist every two months. From January to October she used another 5 sessions. She needed to return to her GP on October 2 to get a new mental health care plan referral to access the remaining 1 session out of the initial 6 available. Following the 6th session her psychologist contacted her GP to get the review item number lodged so she could access another 4 sessions. Another crises had occurred in her life and her depression was returning. After the following 4 sessions she had used her allotted 10 sessions for the year and then was able to access rebates from her private health fund.
Private Health Fund Option:
You may be able to use your Private Health Fund to access rebates on psychological services.
The information on private health fund use is not so clear, but I will do my best to outline it.
- You will likely need to have the top cover plans of your health fund, so check your premium.
- You will need to choose if you are going to use your health fund or medicare. You can't use both at the same time.
- If you have had a Mental Health Care Plan (MHCP) prepared, you are obligated to use all medicare funding before you can access private health fund rebates.
- You can't use both medicare and health fund rebates for the same session. Having an active Mental Health Care Plan (one prepared in the last year) means you have to use these benefits first. Once you have used all medicare offers (10 sessions), then you can use your health fund.
- If you have chosen not to have a Mental Health Care Plan issued, you can use your private health care fund benefits immediately.
- If you are not an Australian resident and do not have a medicare card then you will need non-resident private health cover to act in place of medicare.
Example Private Health Fund rebates for Australian Residents |
Example GU health cover for non-residents |
Frequently-Asked Questions about Medicare and Psychology
Does the mental health care plan go on my medical record?
Yes it does. You will need to talk with your doctor about what is recorded, the limits of its confidentiality and any other ramifications you might be concerned about.
Will having a mental health care plan mean I have to be diagnosed as having a mental health problem?
Yes, it will. The mental health care plan is based on you GP diagnosing some sort of mental health issue (listed below). The most common are depression, anxiety or an adjustment disorder.
How much information will you give my doctor about my treatment
As little as possible. The details of your sessions are confidential. All I need to do is, at the end of 6 sessions, report to your doctor as to how you are doing in general and whether there is a need for another 4 sessions. The details of your sessions are not available to medicare, your doctor, or your health fund. They are confidential, saving very extreme circumstances. See my document (Forms page) on the limits of confidentiality.
I tried to claim my session from medicare but it didn't work, what happened?
Once you have paid for the consultation with your doctor, they "bill" the session with an item number (usually 2701 or similar), and this important step activates your plan with medicare. If, for some reason your MHCP session has not been billed yet (you are trying to claim too soon) or billed with the wrong item number, then medicare won't recognise that you have an active plan.
Yes it does. You will need to talk with your doctor about what is recorded, the limits of its confidentiality and any other ramifications you might be concerned about.
Will having a mental health care plan mean I have to be diagnosed as having a mental health problem?
Yes, it will. The mental health care plan is based on you GP diagnosing some sort of mental health issue (listed below). The most common are depression, anxiety or an adjustment disorder.
How much information will you give my doctor about my treatment
As little as possible. The details of your sessions are confidential. All I need to do is, at the end of 6 sessions, report to your doctor as to how you are doing in general and whether there is a need for another 4 sessions. The details of your sessions are not available to medicare, your doctor, or your health fund. They are confidential, saving very extreme circumstances. See my document (Forms page) on the limits of confidentiality.
I tried to claim my session from medicare but it didn't work, what happened?
Once you have paid for the consultation with your doctor, they "bill" the session with an item number (usually 2701 or similar), and this important step activates your plan with medicare. If, for some reason your MHCP session has not been billed yet (you are trying to claim too soon) or billed with the wrong item number, then medicare won't recognise that you have an active plan.
6.4 If a claim for a GP Mental Health Treatment Plan has not been processed by Medicare Australia first, then the Medicare system will not recognise the patient as being eligible for a rebate in relation to the referred services. In this case, the patient (or patient's GP, if the item is being direct billed to Medicare Australia) should take steps to have the GP Mental Health Treatment Plan item claimed prior to submitting (or resubmitting) the claim for the referred service(s). Note that the date of the referred service(s) must be on or after the date the GP Mental Health Treatment Plan was provided. https://www.health.gov.au/internet/main/publishing.nsf/Content/pacd-gp-mental-health-care-pdf-qa#1_3
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Does medicare get to know details about my sessions with the psychologist?
No, medicare doesn't see your plan or any of the details of your GP session, they just get a number and that number will come up when you go to claim a rebate on a session. Medicare will never see the details of your private sessions with the psychologist. These notes are kept confidential.
Does medicare get to know details about my sessions with the psychologist?
No, medicare doesn't see your plan or any of the details of your GP session, they just get a number and that number will come up when you go to claim a rebate on a session. Medicare will never see the details of your private sessions with the psychologist. These notes are kept confidential.
What mental health problems can be treated under the Better Access initiative?
'Mental disorder' is a term used to describe a range of clinically diagnosable disorders that significantly impact a person's emotions, thoughts, social skills and decision-making. The Better Access initiative covers people with mental disorders arising from:
'Mental disorder' is a term used to describe a range of clinically diagnosable disorders that significantly impact a person's emotions, thoughts, social skills and decision-making. The Better Access initiative covers people with mental disorders arising from:
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For more information visit the Australian Psychology Society page on medicare and psychology:
http://www.psychology.org.au/medicare/fact_sheet/
Department of Health:
http://www.health.gov.au/internet/main/publishing.nsf/content/mental-ba-fact-pat
http://www.psychology.org.au/medicare/fact_sheet/
Department of Health:
http://www.health.gov.au/internet/main/publishing.nsf/content/mental-ba-fact-pat
