Member insider: Mental health support and your private health insurance

Looking after your mental health can feel overwhelming, especially when you’re trying to understand what support is available to you and what costs you may need to plan for – all of which may be the last thing on your mind. The good news is you don’t have to work it all out on your own.

Medicare and private health insurance can both play a role in supporting your care, depending on your cover and the type of treatment you’re accessing. Here, we explain what may be covered, what to ask before you book, and where CBHS may be able to help.

Mental health in Australia

Did you know around one in five Australians experience a mental illness each year, and almost half of us will experience a mental health issue at some point in our lives?

Mental health challenges can look and feel different for everyone. According to SANE Australia, they can affect your mood, thinking patterns, sleep, physical health and relationships. They can also vary in type and severity, which is why getting the right support for your situation matters.

Some types of mental health conditions include:

• depression
• anxiety
• schizophrenia
• mood disorders, e.g. bipolar
• personality disorders
• eating disorders.

If you, or someone you love, is experiencing mental health challenges, reaching out for support and treatment is the first step to living a healthier life. Like many physical health symptoms, mental health challenges often need care, support and time to improve.

Can a GP help with your mental health?

Most mental illnesses can be effectively treated if you reach out for help as soon as you notice any signs and symptoms. Early treatment generally leads to better outcomes, so seeing your GP is a step in a positive direction.

Your GP may begin your care by:

• preparing a mental health treatment plan
• writing a referral for a specialist
• prescribing any appropriate medication if required.

They can also support you by discussing any concerns you may have and advising you on what to do next. You can generally claim part of your GP fees from Medicare. However, some visits are free if you use a doctor who bulk bills.

CBHS does not pay benefits for any GP outpatient costs.

What is a mental health treatment plan?

A mental health treatment plan lets you claim up to 10 Medicare-subsidised individual sessions and 10 group sessions with a mental health professional each calendar year. To be eligible, your GP must refer you to a registered psychologist. Or, in a child’s case, a paediatrician needs to provide this referral.

Psychologist, counsellor or psychiatrist: which one is right for me?

There are different types of mental health professionals, and the right support will depend on your needs, symptoms and treatment goals. Your GP can help guide you towards the most appropriate option.

When should you see a psychologist?

Your GP will help you decide after discussing the mental health issues you’ve been experiencing.

Psychologists can treat a range of mental health issues including:

• 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 and, unlike psychiatrists, they cannot prescribe medicines. You also won’t need a referral from a GP to see a psychologist privately.

Finding the right psychologist can make a real difference, and your GP may be able to help you choose someone suited to your needs. For more information on finding the most suitable psychologist for you, visit the Australian Psychological Society website.

What’s the difference between a psychologist and a counsellor?

When deciding whether to see a psychologist or counsellor, once again, it’s all about research and the level of therapy that’s appropriate for you. Your GP will be able to advise you on this and, in some cases, a counsellor may be a suitable option for you. However, it’s important to note that their training will vary.

Some counsellors will have a background in psychology, social work or nursing, but unlike psychologists and psychiatrists, registration for counsellors and psychotherapists isn’t mandatory. You also won’t need a referral to see a counsellor.

Visit the Psychotherapy and Counselling Federation of Australia (PACFA) website for more information on the different therapy types.

What does a psychiatrist do?

Psychiatrists are medical doctors who have extra qualifications specialising in the diagnosis, treatment and prevention of complex mental, emotional and behavioural health conditions.

To practise in Australia, psychiatrists must be registered with the Royal Australian and New Zealand College of Psychiatrists. If you want to see a psychiatrist, you’ll need a referral from your GP.

Does CBHS cover psychology appointments?

Some CBHS Extras products or packaged covers include benefits towards clinical psychology.

As a reminder, if Medicare pays towards your psychologist treatment, you can’t also claim that same session through CBHS. Once you’ve used your Medicare-subsidised sessions, you may then be able to claim eligible psychology sessions, depending on your cover.

Does CBHS cover counsellor fees?

CBHS does not pay for counsellor fees. Psychotherapists and counselling services are only covered by Medicare if the practitioner is a registered psychologist or social worker with a Medicare provider number.

Does Medicare or private health insurance cover psychiatrist appointments?

If you see a psychiatrist as a public patient at a community health centre or public hospital, the service is likely to be free. However, if you see a psychiatrist in a private practice, Medicare may refund part of the fee if you have a GP referral.

If you're admitted to hospital, CBHS may help cover your psychiatrist's fees, depending on your level of Hospital cover and the benefits payable under your policy. You'll need Gold Hospital cover for the private hospital accommodation portion, though.

Does private health insurance cover inpatient mental health treatment?

Private health insurance can cover the cost of your hospital accommodation and a portion of the medical fees. However, it’s important to note that, since not all Hospital policies will give you full cover for psychiatric services and rehabilitation, you need to choose a policy that doesn’t just partially cover the costs. If you choose a policy that has restricted benefits on psychiatric services, you may have to pay significant out-of-pocket expenses if you’re admitted to a private hospital.

We suggest that you choose our Complete Gold Hospital cover if you’d like to be covered 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 (which estimates the likely cost of treatment) and to find out how much will be covered, how much you will have to pay, and any other expenses.

What waiting periods apply for inpatient psychiatric treatment?

If you’re taking out cover for the first time or upgrading your cover, the standard waiting period to access in-hospital psychiatric services is two months. This also applies if you have a pre-existing condition. All other pre-existing conditions have a 12-month waiting period.

Exemptions to mental health Hospital waiting periods

If your Hospital cover only pays restricted benefits for psychiatric care, you may be able to upgrade for higher psychiatric care benefits without serving another two-month waiting period on the upgrade. This is because of an Australian Government mental health waiting period exemption.

You can only use this exemption once in your lifetime. To be eligible, you must have held any level of Hospital cover for at least two months. If you’d like to check whether this applies to you, call our Member Services team on 1300 654 123.

How do Medicare and CBHS share hospital mental health costs?

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

CBHS (25%) and Medicare (75%) will cover the equivalent of the Medicare Benefits Schedule fee for any treatment you receive as an admitted patient in hospital. However, the remainder or ‘gap’ is at your own expense. You may be able to reduce your out-of-pocket costs by choosing a doctor who has an Access Gap Cover agreement with CBHS. If they do, you can request a written quote at the start of your treatment. There may be some extra out-of-pocket expenses like pharmaceutical costs.

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

Extra support for eligible members

If you hold Bronze Hospital cover or above with CBHS and meet eligibility criteria, we offer a range of programs to assist eligible members diagnosed with a mental health condition to get the support and help they need. Contact our Health & Wellness team on wellness@cbhs.com.au to find out if you’re eligible.

Please note, waiting periods may apply before enrolling, and cover must be held for the duration of the entire program undertaken.

Need mental health support now?

If you have mental health concerns that you want to talk about today, support is only a phone call or click away. You can reach out to your GP for guidance – they may provide you with a range of options for treating and managing any emotional challenges you’re experiencing right now. There is also a range of free support services available to you:

• Beyond Blue - Call 1300 224 636 or chat online.
• Lifeline - Call 13 11 14, text 0477 131 114 or chat online.
• SANE - Call 1800 187 263 or chat online.

The emergency department at your local hospital will also be able to help you, and if you or someone you know is in immediate danger, please call Triple Zero (000).

Put your mental health first today

Australia has some of the most supportive and experienced mental health practitioners in the world. You can access a range of services in-person, online and on the phone. The choice is always yours.

From psychologists and counsellors to psychiatrists and your GP, there’s a network of caring, qualified people ready to help you. You don’t have to carry the burden alone. Putting yourself and your mental health first right now is one of the best things you can do for your future.

If you’re unsure what your cover includes, contact CBHS before booking treatment or going to hospital. We can help you understand what may be covered, what questions to ask, and what out-of-pocket costs you may need to plan for.

All information contained in this article is intended for general information purposes only. The information provided should not be relied upon as medical advice and does not supersede or replace a consultation with a suitably qualified healthcare professional.

Sources
Black Dog Institute: Facts and figures about mental health

Australian Government Department of Health and Aged Care: Mental health and suicide prevention

SANE Australia: What is mental illness?

healthdirect: Mental health treatment plan

Services Australia: Mental health care and Medicare

CBHS: What’s the difference between a psychologist and a psychiatrist?

Australian Psychological Society

Psychotherapy and Counselling Federation of Australia: What is therapy?

CBHS: Extras cover

CBHS: Complete Gold Hospital cover

CBHS: Finding out the cost of your hospital treatment

Australian Government Department of Health and Aged Care: Private health insurance waiting periods and exemptions

CBHS: Find a provider