Psychology and Medicare or Health Fund Rebates
TO LODGE YOUR MEDICARE CLAIM FOR YOU I NEED: The referral date, the doctors name, their provider number and your medicare card details.
The 3 payment options for seeing a psychologist.
1. Yes, you can see a psychologist, without a doctors referral, and just pay the full fee, no problem.
2. MEDICARE REBATES. If you want a refund of $89.65 then a registered psychologist is eligible to provide medicare funded sessions if you have a referral to them through the better access scheme. https://www.psychology.org.au/for-the-public/Medicare-rebates-psychological-services
3. PRIVATE HEALTH FUNDS Some private health levels also provide rebates, but you may only use one option per session. That is, you cannot double dip and use both medicare and private health rebates. You will need to contact your fund to find the amount and the item number the psychologist needs to bill you on. Please also note that some health funds insist you exhaust all medicare refunds before using private health. It is up to you to know the requirements of your private health fund if you choose to use it at all.
To get a medicare rebate for your psychology session
BEFORE you visit your will need a referral letter and forms called a "Mental Health Care Plan" MHCP.
A MHCP can be issued by any doctor, GP, a paediatrician or a psychiatrist.
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 hopefully know exactly what you are talking about, as this is a very common appointment.
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. The doctor will ask you many questions and they may also get you to do a short questionnaire. You don't need to tell your doctor all the details of your situation as you save that for your psychologist :) All your doctor needs to know is that you have psychological symptoms and are experiencing distress and request psychological therapy.
The doctor has to diagnose you into a category of mental disorder e.g. depression or anxiety. 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.
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 possibly 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.
TO LODGE YOUR MEDICARE CLAIM YOU NEED: The referral date, the doctors name and provider number, and your medicare card details.
* Note that while you are eligible for 10 sessions a year, you are only initially issued 6 sessions, you need to return to your GP to have the following 4 sessions issued under the tile of 'review' and your psychologist needs to write to your doctor to authorise the additional 4 sessions.
The 3 payment options for seeing a psychologist.
1. Yes, you can see a psychologist, without a doctors referral, and just pay the full fee, no problem.
2. MEDICARE REBATES. If you want a refund of $89.65 then a registered psychologist is eligible to provide medicare funded sessions if you have a referral to them through the better access scheme. https://www.psychology.org.au/for-the-public/Medicare-rebates-psychological-services
3. PRIVATE HEALTH FUNDS Some private health levels also provide rebates, but you may only use one option per session. That is, you cannot double dip and use both medicare and private health rebates. You will need to contact your fund to find the amount and the item number the psychologist needs to bill you on. Please also note that some health funds insist you exhaust all medicare refunds before using private health. It is up to you to know the requirements of your private health fund if you choose to use it at all.
To get a medicare rebate for your psychology session
BEFORE you visit your will need a referral letter and forms called a "Mental Health Care Plan" MHCP.
A MHCP can be issued by any doctor, GP, a paediatrician or a psychiatrist.
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 hopefully know exactly what you are talking about, as this is a very common appointment.
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. The doctor will ask you many questions and they may also get you to do a short questionnaire. You don't need to tell your doctor all the details of your situation as you save that for your psychologist :) All your doctor needs to know is that you have psychological symptoms and are experiencing distress and request psychological therapy.
The doctor has to diagnose you into a category of mental disorder e.g. depression or anxiety. 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.
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 possibly 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.
TO LODGE YOUR MEDICARE CLAIM YOU NEED: The referral date, the doctors name and provider number, and your medicare card details.
* Note that while you are eligible for 10 sessions a year, you are only initially issued 6 sessions, you need to return to your GP to have the following 4 sessions issued under the tile of 'review' and your psychologist needs to write to your doctor to authorise the additional 4 sessions.
Pay the psychologist fee and get the rebate in your account
At Calm Mind Psychology we have the software to process your medicare refund for you. You will pay the full session fee and Clarissa will enter your referral details and medicare card information into the secure Halaxy software and your rebate of $88.25 for sessions will be process into your account in about 2 days.
At Calm Mind Psychology we have the software to process your medicare refund for you. You will pay the full session fee and Clarissa will enter your referral details and medicare card information into the secure Halaxy software and your rebate of $88.25 for sessions will be process into your account in about 2 days.
Focused psychological strategies for +50 minutes is medicare (MBS) item number 80110 and attracts a rebate of $88.25
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 2019, your referral lasts until 2 October 2020). You are eligible for up to 10 session** rebates per calendar year for individual sessions and another 10 for group sessions. However, your initial referral will be for 6 sessions; after 6 sessions your psychologist will need to write a letter let your doctor know how you are going and if you need the other 4. Then your doctor will lodge a review item number 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. Sessions reset December 31st
So each year you can access 10 sessions, so if you get a MHCP in October, use those sessions before January 1st!
*In 2021, thanks to COVID, you can now get 20 session a calendar year, first 6, then back to GP with a report from your psychologist for another 4, then another visit to the GP. (with psychologists report), to get another 6, repeat for the next 4.
Basically, to get your 20 sessions, you will need 4 visits to the GP and your psychologist will need to write 3 reports. You kick off with 6 with your first doctor letter, then get another 4 after 6th session, then another 6, then another 4: 6/20, 10/20, then 14/20
However, this is neatly within a year, if you are overlapping a year, it all changes a bit - so please take a read and look at the visual on this page.
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.
You may also be able to use your Private Health Fund to access rebates on psychological services.
USING PRIVATE HEALTH FUNDS FOR REBATES ON PSYCHOLOGY 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, I have some examples below.
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 by some health funds 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) might mean you have to use these benefits first.
Once you have used all medicare offers (10 sessions), then you can use your health fund. You need to check with your fund what their requirements are.
If you have chosen not to use medicare and 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.
You will likely need to have the top cover plans of your health fund, so check your premium, I have some examples below.
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 by some health funds 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) might mean you have to use these benefits first.
Once you have used all medicare offers (10 sessions), then you can use your health fund. You need to check with your fund what their requirements are.
If you have chosen not to use medicare and 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. See the table below for a list of issues that warrant a MHCP.
How much information will you give my doctor about my treatment
As little as possible but as much as necessary. 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 except in very extreme circumstances.
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. See insert below
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. See the table below for a list of issues that warrant a MHCP.
How much information will you give my doctor about my treatment
As little as possible but as much as necessary. 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 except in very extreme circumstances.
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. See insert below
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
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, all they get is an item 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.
(See my page on first session information on my limits of confidentiality.
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:
|
Alcohol use disorder
Anxiety disorders Adjustment disorder Attention deficit disorder Bereavement disorder Bipolar disorder Conduct disorder Co-occurring anxiety and depression Depression Drug use disorders |
Eating disorders
Obsessive compulsive disorder Panic disorder Phobic disorder Posttraumatic stress disorder Psychotic disorders Schizophrenia Sexual disorders Sleep problems Unexplained somatic complaints |
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
