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Private health insurance for mental health – are you covered?

03 October, 2017
Mental health

What is mental illness?

About one in five Australians will experience a mental illness, and many of us will experience a mental health problem at some time in our lives.

A mental illness or disorder is a health problem that significantly affects how a person feels, thinks, behaves, and interacts with other people. It is diagnosed according to standardised criteria.

Mental illnesses are of diverse types and degrees of severity. Some of the major types are depression, anxiety, schizophrenia, bipolar mood disorder, personality disorders, and eating disorders.

How can my general practitioner help?

Most mental illnesses can be effectively treated. Recognising the early signs and symptoms of mental illness and accessing effective treatment early is important. The earlier treatment starts, the better the outcome. A visit to a GP should be your first step in seeking help with your problem. Your GP can also prepare a mental health plan, refer you to the right person and prescribe appropriate madication. They can discuss any concerns you have and give you advice on what to do next.

Some aspects of mental health care can be covered on private health insurance, including hospital admissions and psychology services.

How can I claim for my General Practitioner costs?

GP costs are claimable from Medicare. CBHS does not pay benefits for outpatient expenses for GP’s.

How can a psychologist help?

Psychologists can help with a range of mental health issues including issues concerning emotions, thinking and behaviour. The kinds of challenges psychologists address includes anxiety, depression, addictive behaviours, childhood behaviour disorders, relationship problems, eating disorders, sleep problems, sexual problems, bereavement, post-traumatic stress disorder and more.

All psychologists must legally be registered with the Psychology Board of Australia. Many practising psychologists are also members of the Australian Psychological Society. Unlike psychiatrists, psychologists cannot prescribe medicines.

You don’t need a referral from a GP to see a psychologist privately. For more information about finding and seeing a psychologist, talk to your GP or contact the Australian Psychological Society at www.psychology.org.au 

How can I claim for my psychologists' costs?

Some people are eligible for Medicare rebates for 10 sessions each calendar year when treated by registered psychologists under a government scheme. To be eligible, you must be referred to a psychologist by your GP or psychiatrist; or, for children, by their paediatrician.

To find out if you’re eligible for Medicare rebates under the program, please ask your GP.

Some CBHS’ extras products will assist with psychologists’ costs. CBHS recommends our Top Extras cover or Prestige cover for benefits for psychology treatment. Please note that if Medicare pays for your psychologist treatment you cannot claim the cost of the service from CBHS.

How can a counsellor help?

The training background of counsellors can varies. Some will have a background in psychology, social work or nursing, and unlike psychologists and psychiatrists who are required by law to be registered, registration for counsellors and psychotherapists isn’t mandatory. You do not need a referral to see a counsellor.

The training and ethical standards for counsellors and psychotherapists are set by the following professional associations:

  • The Psychotherapy and Counselling Federation of Australia (PACFA). They can be contacted at http://www.pacfa.org.au
  • The Australian Counselling Association (ACA), the professional association of counsellors. They can be contacted at http://www.theaca.net.au

How can I claim for my counsellor’s costs?

CBHS does not pay for counsellor’s fees.

Psychotherapists’ and counsellors’ services are only covered by Medicare if the practitioner is a psychologist or social worker with a Medicare provider number.

How can a psychiatrist help?

Psychiatrists are medical doctors who have extra qualifications specialising in the diagnosis, treatment and prevention of mental illness and emotional problems.  To practice in Australia, psychiatrists must be registered with the Royal Australian and New Zealand College of Psychiatrists.

You will need a referral from a GP to see a psychiatrist.

How can I claim for my psychiatrist costs?

Treatment by a psychiatrist as an outpatient is covered by Medicare. If you see a psychiatrist as a public patient at a community health centre or a public hospital, the service is likely to be free. If you see a psychiatrist in private practice, Medicare will refund part of the psychiatrists' fee.

If you have been treated by a psychiatrist as an admitted patient, CBHS may be able to pay a portion of the fee.

Am I covered in a private hospital?

It is important to ensure you have adequate private health insurance to receive treatment in a private hospital.

Private health insurance can cover the cost of hospital accommodation and a portion of the medical fees.  As not all hospital policies will give you full cover for psychiatric services and rehabilitation, take care to select a policy that does not restrict (only partially cover) or exclude (no cover at all) these services. If you purchase a policy that restricts or excludes psychiatric services, you may have significant out-of-pocket expenses if you are admitted to a private hospital.

CBHS recommends our Comprehensive Hospital cover or Prestige cover for psychiatric treatment in a private hospital.

If you’re expecting a hospital admission, you should contact CBHS, your hospital and your doctor to obtain informed financial consent (likely cost of treatment) and to find out how much will be covered, how much you will have to pay, and any other expenses.

Will I have to serve waiting periods?

Unlike other pre-existing conditions, which normally require you to complete 12 months of membership before you can be covered for a hospital admission, psychiatric services and rehabilitation only require a 2-month waiting period, even if the condition is pre-existing.

This means you can commence a policy or upgrade to a policy with an appropriate level of cover and be covered after 2 months.

How can I claim hospital expenses?

All medical services incurred outside of hospital including psychiatric consultations and check-ups, like your visits to your GP, can only be claimed on Medicare.

CBHS (25% of the fee) and Medicare (75% of the fee) will cover the equivalent of the Medicare Benefits Schedule fee for treatment received as an admitted patient, but the remainder is your own expense. Discuss the situation with your doctor – ask if he or she has an Access Gap agreement with CBHS and request a written quote of expenses at the start of your treatment. Some additional out-of-pocket expenses you may incur include pharmaceutical expenses.

If you have an excesses and co-payments on your policy you will need to pay the excess or co-payment directly to the hospital on admission.

Can CBHS help in any other way?

If you hold a hospital cover with CBHS, our Better Living Programs may be of assistance.

Our Mental Health Clinician enables you to calmly address your problems and issues in a supportive environment so that a greater understanding can be achieved. This can assist you to make positive changes or it may help someone accept a difficult situation and become more resilient.

Our Better Living program provides support such as visits from registered mental health nurses, assessing your individual needs, supporting medication regimes and helping to determine and coordinate appropriate care.

Follow this link to the Better Living Program webpage - https://www.cbhs.com.au/why-join-cbhs/member-benefits/better-living

Members also have the option of requesting a call back from CBHS’s team via this link - https://offers.cbhs.com.au/wellness-callback

How can I claim the CBHS Better Living Program?

If you hold an appropriate level of CBHS Hospital cover, there will be no out of pocket expenses for participating in the program.

What if I need help now?

Your GP can provide you with a range of options for treating and managing mental health issues. The emergency department at your local hospital will also be able to help you.

If you need support, please call Lifeline on 13 11 14 or visit www.lifeline.org.au/gethelp or call the Beyond Blue Support Service on 1300 224 636 or visit www.beyondblue.org.au/about-us/contact-us

Follow this link for details on Government assistance http://www.health.gov.au/internet/main/publishing.nsf/content/mental-ba-fact-path

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