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Rebate Reality!!!


Medicare rebates for mental health therapy services can be very confusing for both GP’s & people seeking support!


Many people think getting rebates for therapy sessions is always a better option, & therefore they may seek out only Medicare accredited providers for treatment.


In reality, this may not be the case. I’m here to show you the best way to choose a mental health professional, & how to calculate costs to save you money!!!


Medicare Rebates for Therapy Services


At the time of writing (end of 2023), GP’s & psychiatrists can provide patients dealing with mild to moderate mental health issues with what’s called a ‘GP Mental Health Care Plan’ & referral for psychological therapy.


This referral allows the patient to claim between $83- $93 (average) per counselling session with a Medicare accredited provider, for up to a maximum of 10 sessions per calendar year.


The GP initially approves the patient for 6 sessions of counselling, then must do a review, no sooner than 3 months later, to approve an additional 4 sessions if applicable.


Medicare accredited providers that can provide services under GP Mental Health Care Plans are:

  • Registered & Clinical Psychologists

  • Accredited Mental Health Social Workers

  • Accredited Mental Health Occupational Therapists


At the beginning of each calendar year, the GP can review the patient & approve them for an additional 6 + 4 sessions.


The timing of the GP Mental Health Care Plan has a big impact on whether patients can have continual sessions attracting rebates, or whether they will have a period of time (possible many months) where they cannot claim any more rebates.


Examples


Example #1:


Kate (18) visits her GP in February 2023 & reports she is struggling with anxiety. The GP diagnoses Kate with Generalised Anxiety Disorder, completes a Mental Health Care Plan & referral letter for Kate to see a registered psychologist at a clinic the GP is aware of.


Kate books & attends 6 fortnightly sessions with the psychologist between February- May. The psychologist charges $220 per session, & Kate claims back $93 per sessions for each of her 6 sessions.


In May, Kate then returns to her GP & they approve her for an additional 4 sessions under her Mental Health Care Plan.


Kate attends a further 4 sessions with the psychologist between May- July, & gets back $93 per session for each of her sessions.


At this point, Kate has paid $220 each for 10 sessions with the psychologist, equalling a cost of $2,220.


She gets back $93 per session for the 10 sessions, equalling $930.


Therefor, Kate’s out-of-pocket expenses between February & July are $1,270 after rebates.


However, from July onwards Kate cannot get any further rebates, as she has used her maximum allowance of 10 per calendar year.


Kate feels she needs further sessions with the psychologist, & continues to attend monthly from July- December. This ends up costing her an additional $1,320 in fees for the extra 6 sessions.


Kate’s total out-of-pocket fees for the year for her therapy, come to $2,590.


Example #2:


Jamie (25) has been struggling with their mental health for several years now, including anxiety, panic attacks, chronic depression & self harm.


Jamie asks family & friends for recommendations, & finds a registered counsellor who they feel like might be a good fit for them.


Jamie calls to inquire about their service, & is advised the counsellor’s fees are $150/ session. Counsellors are not currently Medicare accredited, so there are no Medicare rebates available.


Jamie sees the counsellor fortnightly for 10 sessions between February & July, then continues monthly the rest of the year. The total sessions Jamie attends are 16, at a cost of $2,400.


As you can see, even thought Jamie has seen a non-accredited provider, they have actually paid less for the course of their treatment.


In reality, given the severity & duration of Jamie’s symptoms, they would be better with fortnightly sessions for the whole year (rather than dropping to monthly).


Seeing a non-accredited provider fortnightly for 12-months would be significantly cheaper for Jamie than with an accredited provider.


If Jamie attended fortnightly sessions for 12-month at $150/ session, their out-of-pocket costs would be $3,900 (26 sessions).


With an accredited provider at $220/ session fortnightly for 12-months, out-of-pocket costs, after rebates, would be $4,790 (26 sessions).


This is a saving of $890.


Myths About Mental Health Professionals


Medicare accredited mental health providers are more experienced than non-accredited providers:


A mental health professionals Medicare accreditation status is based entirely on their formal qualifications, not on amount of type of experience.


For example, a registered psychologist just our of university is Medicare Accredited. A Registered Counsellor with 20 years experience is not.


Certainly a counsellor with 20 years of experience is a more experienced provider!


Rebates will make treatment cheaper:


There are some situations where Medicare rebates may, over a course of treatment, be cheaper for the patient. However, this is only in cases of brief treatment (6-10 sessions). For people wanting or needing more than 10 sessions of counselling, the cost of treatment will generally be higher with rebates than without.


This is because Medicare accredited providers charge more for their services, in many instances to cover the significant costs associated with maintaining accreditation through their professional bodies. This cost is understandably passed onto patients.


Non-accredited providers don’t have these extra costs, so can offer lower fees.


Non-accredited providers are not registered & therefor are higher risk to see:


Providers such as social workers, OT’s & counsellors are often still registered with their professional body, carry insurance to conduct their work & have ongoing professional development requirements to keep their registration current.


Look for providers who either work with a reputable & registered practice, or have information about their professional registration status available.


Watch our for providers using titles such as ‘life coach’ or general (not registered) ‘counsellor’, as these are not protected titles & can be used by anyone regardless of formal qualifications.


Finding the Right Provider


When looking for the best mental health provider for you, consider the following:


Focus on speciality:


Find a professional who has experience working with your particular issues. For example, if you are struggling with complex- PTSD, find a professional who does this in their daily work.


Better yet, research the recommended therapies for your symptoms & find providers who practice those. For example, for C-PTSD, dialectical behavioural therapy is considered a recommended treatment, so find a professional who does DBT.


Beware of professionals who list all specialities in their information!!! Choose someone who specialises- you will get a better service.


Don’t just rely on your GP for referral choices:


GP’s are so busy, & may not be aware of the large range of different therapies available for your symptoms. Many GP’s refer all mental health presentations to 1 clinic, which may not have the specialty you need.


Instead, do some research yourself before you see your GP, & ask them if they are aware of the services you find that you are most interested in.


Most GP’s are happy to get information from patients about services they have found & are happy to make referrals as long as the service is registered & reputable.


Consider length & intensity of treatment:


If you need only 6-10 sessions with a therapist & your symptoms are fairly minor, you may save money going with a Medicare accredited professional.


However, if you know you want or need medium to long-term care, or your issues are more medium to high intensity, you may save money with a non-accredited provider.


Again, look for professionals who provide & specialise in more intensive &/or long-term treatment.


More Info & Support


If you or someone you care about wants medium to long-term support, or has more intense or long-standing mental health struggles, consider contacting us at Mindful Recovery Services.


We specialise in complex mental health needs & we have a range of programs that we can tailor for your needs. We see people from age 13 & over & would love to help!!!


Some of our providers are Medicare accredited & others are not. We hire team based on experience & skills rather than professional titles. We offer competitive pricing, payment plans & a range of services to give you excellent value for money.


Drop us a line today!!!

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