Private Health Insurance and Psychology Rebates
Many private health insurance extras (general treatment) policies pay a benefit toward psychology sessions, but cover varies widely between funds and policies. Typically, your policy will pay a set dollar amount per session up to an annual limit, and only if psychology is included in your level of cover and you've served any waiting period. You generally can't claim both Medicare and your health fund for the same session, so it's worth working out which gives you the better result.
How extras cover for psychology works
Psychology is usually included in mid to top-level extras policies, and sometimes in basic ones. The key features to check are:
Whether psychology is included in your specific policy
The benefit per session: a fixed dollar amount, or a percentage of the fee
Annual limits: the maximum your fund will pay for psychology in a year, which may be shared with other services such as physiotherapy or counselling
Waiting periods: commonly two months for general extras services, but this varies
Which practitioners are recognised: most funds require the psychologist to be registered with Ahpra and recognised by the fund. Some funds don't pay benefits for sessions with provisional psychologists, and cover for counsellors varies between funds
Whether telehealth is covered: many funds now pay benefits for telehealth psychology sessions, but check your policy
Item numbers and claiming
Health funds use their own item codes for psychology, usually separating an initial consultation from subsequent ones, and sometimes group sessions. These aren't the same as Medicare item numbers. To claim:
Ask your fund whether psychology is covered, how much they'll pay per session, what's left in your annual limit, and whether the practitioner you're seeing is recognised.
Get the right paperwork. Your psychologist will provide an itemised receipt with their provider details and the service type.
Claim through your fund's app, website or in person. Some practices can process claims on the spot if they have an electronic claiming terminal. Ask the practice what's available.
Medicare vs private health insurance
You can't claim a Medicare rebate and a health fund benefit for the same session. For each session, you'll use one or the other.
Referral needed — Medicare (Better Access): Yes: Mental Health Treatment Plan from your GP; Private health extras: Usually no
Session limit — Medicare (Better Access): Up to 10 individual sessions per calendar year; Private health extras: Depends on your annual limit
Rebate per session — Medicare (Better Access): Set by the Medicare Benefits Schedule; Private health extras: Set by your fund and policy
Practitioner — Medicare (Better Access): Eligible psychologists and other eligible providers; Private health extras: Recognised practitioners, as defined by your fund
Diagnosis — Medicare (Better Access): GP assesses a mental health condition; Private health extras: Generally not required
Couples therapy — Medicare (Better Access): Not covered; Private health extras: Covered under some policies; check with your fund
Which should I use?
Some common approaches:
Use Medicare first, particularly if the Medicare rebate is higher than your fund's benefit, then use private health once your Better Access sessions are used up for the year.
Use private health if you'd prefer not to get a GP referral, if you want sessions not covered by Medicare (such as couples therapy), or if your fund's benefit is similar and you want to save your Medicare sessions.
Combine across the year: for example, Medicare for your 10 individual sessions, then extras cover for further sessions.
Private health benefits usually reset on a calendar or membership year, depending on your fund. Check which applies.
Hospital cover and mental health
Hospital cover is different from extras. Some hospital policies cover inpatient psychiatric care. Under federal rules, once you've held hospital cover for at least two months, you can upgrade to a higher level of psychiatric cover once in your lifetime without serving the usual waiting period for that upgrade. The Commonwealth Ombudsman has a useful fact sheet on mental health treatment and private health insurance.
Questions to ask your health fund
Does my policy include psychology?
How much will you pay per session, for initial and subsequent consultations?
What's my annual limit, and is it shared with other services?
Have I served the waiting period?
Are telehealth sessions covered?
Do you recognise provisional psychologists and counsellors?
Do you cover couples sessions?
Does my limit reset on 1 January or on my membership anniversary?
Claiming with Satya Psychology
Our fees are listed on our services page. You'll receive a receipt through our online booking system after each session, which you can use to claim from your fund if your policy covers the service. Because cover differs between funds, practitioner types and session formats (such as couples, telehealth or Walk and Talk), check with your fund before your first session so there are no surprises.
For more on Medicare, read Medicare Mental Health Care Plans Explained. When you're ready, book a session.
This article is general information and isn't financial advice. Health fund rules vary; always confirm your cover directly with your fund.