Better Access to Mental Health Care: Medicare funded services

Medicare rebates are available for psychological treatment by registered psychologists under the Australian Government's Better Access to Mental Health Care initiative. This scheme provides considerable assistance to people living with mental health problems, allowing them greater access to psychologists and providing more affordable mental healthcare.

Under this scheme individuals diagnosed with a mental health disorder can access up to 10 individual and 10 group treatment sessions per year.
 

Psychologists study the way people feel, think, act and interact. Through a range of strategies and therapies they aim to reduce distress and to enhance and promote emotional wellbeing. Psychologists are experts in human behavior. They have studied the brain, memory, learning and human development. Psychologists can assist people who are having difficulty controlling their emotions, thinking and behaviour, including those with mental health problems such as anxiety and depression, serious and enduring mental illness, addictive behaviours and childhood behaviour disorders.

All psychologists are registered with the national registration board, the Psychology Board of Australia, in the same way medical practitioners must be registered. This means that they must be competent and follow a strict Code of Conduct.

Not all counsellors or therapists are registered psychologists. Seeing someone who is registered ensures you receive high quality ethical treatment.
 

Psychologists are experts in providing therapies for mental health problems. These therapies are effective in treating mental health conditions including for example, anxiety, depression, alcohol use disorders and eating disorders, as well as a range of childhood problems such as attention deficit hyperactivity disorder and conduct problems.
 

'Mental disorder' is a term used to describe a range of clinically diagnosable disorders that significantly impact on a person's emotions, thoughts, social skills and decision-making. The Better Access initiative covers people with mental disorders arising from:

• Alcohol use disorder
• Adjustment disorder
• Attention deficit disorder
• Bereavement disorder
• Bipolar disorder
• Chronic fatigue
• Conduct disorder
• Co-occurring anxiety and depression
• Depression
• Dissociative disorder
• Drug use disorder
• Eating disorders
• Enuresis
• Generalised anxiety disorder
• Mental disorder, not otherwise specified
• Obsessive compulsive disorder
• Panic disorder
• Phobic disorder
• Posttraumatic stress disorder
• Psychotic disorders
• Schizophrenia
• Sexual disorders
• Sleep problems
• Unexplained somatic complaints

To access mental health treatment under Medicare you must be referred by your GP, a psychiatrist or a paediatrician. If a GP is the referring practitioner he or she will need to prepare a Mental Health Treatment Plan before referring you to a psychologist. You should book a longer session with your GP to enable time for this.

Under the scheme a psychologist must be registered with Medicare and have a Medicare Provider Number in order to be able to provide services under the Better Access scheme.
 

Your doctor must first assess that you require the services of a psychologist. Your doctor may allow you to request a specific psychologist or may refer you to a registered psychologist that he/she recommends. The psychologist in question must have a Medicare Provider Number for you to be able to claim the Medicare rebate.

In order to receive a Medicare rebate under the Better Access initiative, you must be referred to a psychologist by an appropriate medical practitioner (GP, psychiatrist or paediatrician). The doctor must first make an assessment that you need the services of a psychologist. If you are already seeing a psychologist, discuss this with your doctor.
 

Medicare is Australia's universal public healthcare system. A Medicare Provider Numbers is issued by Medicare Australia to a practitioner who is eligible to provide services under a particular initiative for which a Medicare rebate can be claimed. The practitioner must use this number on any invoice provided to a patient/client seen under Medicare.
 

Under the Better Access initiative, eligible people can receive:

• Up to 10 individual sessions in a calendar year (1 January to 31 December). 
• Up to 10 group therapy sessions in a calendar year where such services are available and seen as appropriate by your referring doctor and the psychologist.

Referrals cannot be provided for the full 10 sessions. A referral is for a maximum of six sessions. Your referring doctor will assess your progress after the first six sessions and determine whether further sessions are needed.

After you have reached the maximum number of allowable sessions for the calendar year you will not be eligible for any further Medicare rebates for treatment you receive from a psychologist until the new calendar year.

The cost to you will vary depending on the length of the session and the fee being charged by the psychologist.

The cost for a psychological therapy session is usually greater than the Medicare rebate, so it is likely that you will need to pay the difference between what the psychologist charges you and the Medicare rebate.

In some instances a psychologist may choose to bulk bill (i.e., aged pensioners, health care card holders), in which case you will not have to pay anything.

The payment arrangements will vary and you should check these with the psychologist before commencing your treatment.
 

The settlement of the account is to be determined by you and the psychologist. If the psychologist bulk bills you then there will be no payment to be made. If billed, following payment many psychologists will be able to put your claim through to Medicare to be reimbursed directly into your bank account. If the psychologist does not have this facility you can either:

• Pay the full amount of the consultation and use your detailed receipt to claim a Medicare rebate; or
• With the psychologist’s agreement, pay the difference between the Medicare rebate and the total account amount, and then claim the rebate from Medicare to forward to the psychologist later; or
• With the psychologist’s agreement, claim from Medicare using your unpaid account and make the payment to the psychologist.

If the psychologist decides to use the bulk billing method, you assign your right to a benefit to the psychologist as full payment for the psychological service. The psychologist cannot make any additional charge for this service if it has been bulk billed, and will receive the relevant Medicare rebate or 'benefit' from Medicare Australia for the service provided.

Yes. You are responsible for paying any charges in excess of the Medicare rebate. However, these out-of-pocket expenses will count towards the Medicare Safety Net.

Once you or your family reach the relevant threshold in the calendar year, Medicare benefits will increase to 100 per cent of the Government-determined schedule fee under the original Safety Net, and 80 per cent of your total out-of-pocket expenses for out-of-hospital services under the extended Medicare Safety Net. The Medicare Safety Net is designed to protect high users of health services from large out-of-pocket expenses.

Visit the Medicare website for more information on the Medicare Safety Net.

You cannot use your private health insurance ancillary cover to top up the Medicare rebates.

You need to decide if you will use Medicare or your private health insurance ancillary cover to pay for any psychological services you receive. That is, you can either access rebates from Medicare by following the claiming process or claim where available on your insurer's ancillary benefits.