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My Fee Schedule compared to Medicare Rebate
https://www.medibank.com.au/health-support/mental-health/using-cover/Currently, clients accessing counselling services through psychotherapists and counsellors are not able to claim Medicare rebates. The Australian Counselling Association, on behalf of its members, is working with the Health Insurance Commission and other bodies to resolve this rebate issue.
To access a Medicare rebate, you need to be diagnosed with a mental illness or disorder and get a referral from your doctor. The fee for psychiatrists/psychologists/social workers is around $170-$250. Unless you are being bulk-billed, the out-of-pocket cost after Medicare rebate is anywhere between $85 – $125. The number of therapy sessions available under Medicare is restricted to 6 individual sessions and a maximum of 10 per calendar year (additional sessions require a new referral from your doctor).
The average counselling fee with a psychotherapist or counsellor is around $110-$180 and you may be able to claim a rebate if you have extra covers with your private health fund, so it works out much of a muchness. You do not need to be on a Mental Health Plan or have a doctor’s referral and there is no restriction on how many sessions you can have a year.
I am a provider with the following private health funds: Bupa, Medibank Private, ahm and HCF with whom you may be entitled to claim a rebate, depending on your health insurance cover. Please contact your health fund directly for further information.
Please Note – Couple Counselling is not covered under the Medicare mental health program unless one partner is diagnosed as having a mental illness and couples counselling may help to address it directly.
The Pros and Cons of Claiming Medicare Rebate:
With Medicare Rebate
- To access the Mental Health Plan, you need a referral from your GP to see a psychiatrist, or a psychologist or a social worker.
- To claim a rebate from Medicare, the treatment must be “medically necessary”, which means that you must be diagnosed with a mental illness or disorder.
- Once you are on a Mental Health Plan, your diagnosis becomes part of your health records forever.
- Your private information: psychiatric diagnosis; presenting issues, treatment plan and progress reports are available to the insurance company, on MyHealthRecord.gov.au, and sometimes to employers and adoption agencies.
- Medicare, some private health funds and EAPs limit the choice of therapist and the type of therapy that you can use. For example – CBT, is the most commonly used therapy due to a shorter time treatment, therefore is cost-effective for the Government to fund the mental health plan.
- The length of treatment is usually limited to 6 sessions per year. For some serious cases, a second referral from a GP is required for additional 4 sessions.
- Having a psychological diagnosis on your health records can restrict your ability to qualify for future health and life insurance coverage, as well as when applying for some jobs or becoming an adoptive parent. Please click on the links in red to access media stories on some insurance exclusions.
- Medicare is a medical model, provides short, sharp outcomes, but this brief treatment may not address underlying core issues that require deeper and longer work.
No Medicare Rebate:
- You don’t need a doctor referral to see a psychotherapist or a counsellor.
- You can choose the type of therapy that is best suited for your problems.
- There is no restriction on how many sessions you can have a year.
- A psychotherapist/counsellor can help you with issues such as emotional and personal growth, coping with stress, anxiety, self-esteem, marital and family difficulties as well as other psychological problems.
- Your personal information, presenting issues, diagnosis are kept confidential with your therapist. However, you will not have a mental health diagnosis permanently recorded on your health records for others to access.
