Making treatment more affordable

By Rebecca Guzelian

Psychological treatment can often be costly for clients, and we find this is particularly the case when working with illnesses such as eating disorders that can frequently require extended time in treatment. There are many ways in which the cost of accessing psychological treatment can be managed in order to allow for greater access to services.

Medicare Better Access Initiative

Under Medicare’s Better Access initiative, clients can access Medicare rebates for psychological services to cover part of their consultation cost. These rebates can only be accessed through referral by your general practitioner (GP), psychiatrist or paediatrician, and require a Mental Health Treatment Plan to be completed. Rebates for seeing a Clinical Psychologist are currently $124.50 per consultation, and rebates for seeing a registered Psychologist are currently $84.80 per consultation. Depending on your health care needs, following the initial course of treatment (a maximum of six sessions but may be less depending on your clinical need), you can return to your GP or psychiatrist/paediatrician and obtain a new referral to access an additional four sessions, to a maximum of ten individual and ten group sessions per calendar year.

The purpose of the Better Access initiative is to improve treatment and management of mental illness within the community. The Better Access initiative aims to increase community access to mental health professionals and team-based mental health care, with GPs encouraged to work more closely and collaboratively with psychiatrists, clinical psychologists, registered psychologists and appropriately trained social workers and occupational therapists.

Medicare Chronic Disease Management

Another option that may be utilised in some circumstances to access further Medicare rebates towards psychological services is through a Medicare Chronic Disease Management (CDM) plan. The rebates accessible for items under a CDM plan are currently $52.95 per consultation up to a maximum of 5 sessions per calendar year.

The CDM plan enables GPs to plan and coordinate the health care of patients with chronic or terminal medical conditions, including patients with these conditions who require multidisciplinary, team-based care from a GP and at least two other health care providers. A chronic medical condition is one that has been (or is likely to be) present for six months or longer. Given the seriousness of eating disorders, and other mental health conditions it is likely that a proportion of clients seeking psychological services would meet the requirements for access to items under a CDM plan. There is no list of eligible conditions; however, the CDM items are designed for patients who require a structured approach, including those requiring ongoing care from a multidisciplinary team.

Patients who have a chronic medical condition and require ongoing care from a multidisciplinary team of at least three health care providers (e.g. GP, Psychologist, Psychiatrist, Paediatrician etc.) are eligible for a Team Care Arrangement (TCA) under the broader CDM plan. A TCA involves the GP collaborating with the other participating providers on required treatment/services, agreeing to arrangements with the patient, documenting the arrangements and a review date in the patient’s TCA, and providing copies of the relevant documents to the collaborating providers.

Whether a patient is eligible for CDM services is a clinical judgement for the GP, taking into account the patient’s medical condition and care needs, as well as the general guidance set out in the Medicare Benefits Schedule (MBS). Patients with a mental disorder only, who require a treatment plan to be prepared, should first be managed under the GP Mental Health Treatment Plan (as outlined above under the Medicare Better Access initiative). Where a patient has a mental disorder as well as significant co-morbidities and complex needs requiring team-based care, the GP is able use both the CDM items (a TCA for team-based care) and the GP Mental Health Treatment Plan.

Private Health Insurance

For clients who are covered with private health insurance including ‘extras’ or ancillary cover, rebates may be available for consultations with clinical or registered psychologists. If your health fund covers psychological treatment, your fund will pay a set benefit or percentage of the cost of the service, and you pay the rest. The rebate that is paid by your private health fund is determined by a number of factors including your chosen level of cover and your specific fund’s procedure for payment of rebates – details of which can be found in your product disclosure statement or by contacting your health insurer. In order to access rebates, your provider needs to be registered with your health fund, so you should check this with your fund before sending in a claim.

Low Cost Treatment

Psychologists will at times be able to offer time bound low cost treatment for existing clients, determined on a case-by-case basis. If your financial situation is contributing as a barrier toward continuing in regular treatment, please speak with your treating psychologist as they may be able to use discretion in finding an appropriate way forward with treatment.

For those clients who are seeking a permanent lower cost treatment option, they may like to consider treatment from our intern psychologist. Intern psychologists are provisionally registered psychologists that have completed all formal tertiary studies required to become a psychologist, and are in the process of completing a period of ‘supervised practice’ in the workplace in order to gain full registration as a psychologist. Treatment provided by these therapists is normally at a much lower cost than that of psychologists with full registration. For more information on low cost treatment options you can read more here.

NOTE: One of our readers has also kindly pointed out, since this article was published:
“Accredited Mental Health Social Workers” are also part of the “Medicare Better Access Initiative”. Clients who have a Mental Health Care Plan are entitled to a rebate of $74.80 per session.  

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