Member Insider - Mental health and your health insurance

Did you know that approximately one in five Australians will experience a mental illness each year? What’s more, almost half of us will have a mental health issue at some point in our lives.

SANE Australia describes mental health issue as a wide range of conditions that affect how we think and feel. This can go on to determine how we behave and interact with others. Mental illnesses are diverse in type and vary in degrees of severity.

Some of the major types include:

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

If you, or someone you love, is living with a mental illness or poor mental health, reaching out for support and treatment is the first step to living a healthier life. Just like physical symptoms, mental health issues don’t just go away on their own.

Your GP can help with your mental health in the first instance

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 will begin your care by:

• preparing a mental health 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. In terms of costs, you can claim part of your GP fees from Medicare. However, some visits can be free if you use a doctor who bulk bills.

CBHS does not pay benefits for any GP outpatient costs.

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.

Selecting the right psychologist for you is vital. So, doing your research or consulting with your GP on the specialist who will suit your particular challenges is very important. For more information, contact the Australian Psychological Society.

If you have a Mental Health Care Plan, some of your psychology sessions are subsidised by Medicare

A mental health treatment plan lets you claim up to 10 Medicare-subsidised individual sessions and 10 Medicare-subsidised 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.

Can your CBHS cover support your journey towards recovery?

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

As a reminder if Medicare pays towards your psychologist treatment, you cannot also claim it from CBHS.

Should you choose a counsellor to help you instead?

When making a decision on whether you should see a certified 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 it may be that a counsellor is all the professional support you need. However, it’s important to note that their training will vary.

Some 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.

Once you’ve spoken with your GP and, to help with your decision, you can also visit The Psychotherapy and Counselling Federation of Australia (PACFA) website for their description on therapy. It’s based on developing a person’s self-knowledge in order to make positive life changes.

Claiming your counsellor costs

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.

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 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.

Can you claim for the cost to see a psychiatrist?

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 will refund part of the fee.

CBHS may cover your psychiatrist fee when you are admitted.

Will you be covered in a private hospital?

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 Gold tier 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.

Are there any waiting periods?

Your CBHS cover can help in the recovery process. You may be able to access specialised psychiatric care and support with the required two-month waiting period. This also applies if you have a pre-existing condition. This means you can take out a new policy or upgrade to a policy with an appropriate level of cover and be covered after two months.

Changes to waiting periods for a mental health admission

In the past, if you were covered by a Hospital policy with restricted benefits for psychiatric care, you had to upgrade and complete a two-month waiting period before being able to access your additional benefits. However, from 1 April 2018, the Australian Government has mandated that you can upgrade for access to higher psychiatric care benefits in a private hospital without having to serve the additional waiting period on the upgrade.

This exemption applies only once per lifetime and is only available if you have already been a member for two months on any level of Hospital cover. If you’d like more details about this exemption, you can call our Member Services team on 1300 654 123.

How to claim your hospital expenses

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. However, the remainder or ‘gap’ is at your own expense. That’s why it’s a good idea to discuss this with your doctor to find out if they have an Access Gap Cover Scheme agreement with CBHS. If they do, you can request a written quote at the start of your treatment. Also, there may be some extra out-of-pocket expenses like pharmaceutical costs.

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

CBHS is here to help you in any way we can – introducing Better Living

If you hold Hospital cover with CBHS and meet eligibility criteria, we offer a range of programs to assist eligible members living with mental illness to get the support and help they need. Contact our Health & Wellness team via email on wellness@cbhs.com.au to find out if you are eligible.

What’s more, if you have appropriate CBHS Hospital cover, you won’t incur any out-of-pocket expenses related to joining these programs.

Please note, you'll need to hold 2 months of consecutive cover before enrolling in those programs, as well as remain covered for the duration of the entire program.

Do you need help now? Remember, you’re never alone.

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.

You can also get in touch with one of many mental health websites for online and phone support. The emergency department at your local hospital will also be able to help you. And if you are in Australia, you can ring Lifeline on 13 11 14 or Kids Helpline on 1800 551 800 for specialised 24-hour help, support and advice.

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 general practitioner, there’s a network of caring, qualified people ready to help you. So, you needn’t 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.

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:

What’s the difference between a psychologist and a psychiatrist? (cbhs.com.au)

Search for a health service provider (cbhs.com.au)

Finding out the cost of your hospital treatment (cbhs.com.au)

National help lines and websites - Beyond Blue

What is Therapy? (pacfa.org.au)