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Medicare safety net

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SFA

I've just checked this with Medicare and I feel like the answer I got doesn't really make sense. So I'm wondering if someone here has been in the same situation.

 

I've used up all my rebates from a mental health care plan for this year and I'm seeing my psychologist weekly as part of a group program. Because I'm not getting the rebate, I've not been submitting my receipts to Medicare. But I was wondering how those sessions count towards my Medicare safety net balance if they're not being submitted to Medicare.

 

The answer was that because they're not "claimable" (although I'm not sure what the definition of that is), they can't be submitted and hence won't count. There's 5 more months worth of them at a session a week, approx $200 per session, so it's not just a little bit of money.

 

Has anyone ever been in a similar situation?

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BusbyWilkes

My understanding was that only medical apts (doctor) count towards the safety net. So what you were told is correct - you can’t claim them or count them towards the safety need as it’s for psychology apts.

 

Yes, it sucks.

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triangle

I would assume they are private sessions?

 

Your care plan ones would be funded by Medicare, with you paying the gap. Say 5 sessions per calendar year.

I would then assume Medicare only covers the 5 sessions. More than that do not attract a Medicare billing code, are done privately through the psych, and no Medicare associated?

 

I could be wrong but that would be my understanding.

Maybe every appt attracts a Medicare billing code? I don’t know. What do you receipts say?

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triangle

Have you gone to gp for mental health care plan review? It’s been a few years since I’ve been involved with these, so I may be off mark. This may have entitled you to further rebate attracting sessions?

Someone will know more than me though on that.

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SFA

I would assume they are private sessions?

 

Your care plan ones would be funded by Medicare, with you paying the gap. Say 5 sessions per calendar year.

I would then assume Medicare only covers the 5 sessions. More than that do not attract a Medicare billing code, are done privately through the psych, and no Medicare associated?

 

I could be wrong but that would be my understanding.

Maybe every appt attracts a Medicare billing code? I don’t know. What do you receipts say?

 

The receipts are always the same, they always have the Medicare billing code because my psychologist doesn't know which ones I might choose to claim the rebate on.

 

Have you gone to gp for mental health care plan review? It’s been a few years since I’ve been involved with these, so I may be off mark. This may have entitled you to further rebate attracting sessions?

Someone will know more than me though on that.

 

Yes, I've had the review. I've had rolling mental health care plans for years, so am pretty used to the process.

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SFA

My understanding was that only medical apts (doctor) count towards the safety net. So what you were told is correct - you can’t claim them or count them towards the safety need as it’s for psychology apts.

 

Yes, it sucks.

 

I know it's not a Medicare link, but this seems to be saying they do count. And by the amount on my safety net right now, I'd say they must, because they definitely haven't spent that much on doctors appointments only.

 

https://www.psychology.org.au/for-the-public/Medicare-rebates-psychological-services/Medicare-FAQs-for-the-public

 

It's so confusing! Hence the post

Edited to add:

 

This is from a government page is referring to psychological services and says:

 

Out-of-pocket expenses and Medicare safety net

 

Charges in excess of the Medicare benefit for these items are the responsibility of the patient. However, if a service was provided out of hospital, any out-of-pocket costs will count towards the Medicare safety net for that patient. The out‑of‑pocket costs for mental health services which are not Medicare eligible do not count towards the Medicare safety net.

 

 

So that makes me think the rebated sessions are covered as "Medicare eligible" sessions and the rest aren't.

Seems a bit odd for me, as to be needing to see a psychologist so regularly for a complex mental illness, you're already disadvantaged by not getting the rebate for so many sessions and then to not have it count towards your safety net balance you're disadvantaged further.

Edited by StoneFoxArrow

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BusbyWilkes

So, I think the gap between what was charged for the rebatable sessions and what the rebate was will count towards the Medicare safety net (as you are accessing those sessions under a Medicare plan). Does the amount in the safety net match that scenario?

 

Once the Medicare plan is finished, you are then seeing the psych as a fee paying customer so no rebate and no contributing to safety net. Can only get discount via private health. Or let your provider know that you are having to pay the whole amount, which is difficult, and ask if they can subsidise your sessions (especially if it is months of group work).

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*bucket*

 

 

So that makes me think the rebated sessions are covered as "Medicare eligible" sessions and the rest aren't.

 

 

This has always been my understanding and experience. Sucks big time.

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SFA

You may already be aware of this but FYI the GP plans can cover up to 10 individual sessions AND 10 group sessions. I didn’t realise it effectively gave access to 20 mental health visits.

 

https://www.servicesaustralia.gov.au/organisations/health-professionals/topics/education-guide-better-access-mental-health-care-eligible-practitioners-and-allied-health/35591

 

Yeah, the group class I'm doing doesn't fit into the Medicare definition of "group classes"...

Also I think the rebate is significantly less than it is for the individual sessions.

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born.a.girl

My understanding is that the ones which qualify for Medicare (from your plan) give you 1) a rebate and 2) OOP is added to your safety net figure.

 

Those sessions which don't qualify for a medicare rebate, are nothing to do with medicare.

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chicken_bits

This has always been my understanding and experience. Sucks big time.

 

Yes, this is correct. E.g. I have a CDMP for 5 sessions with my Osteopath which gets billed under medicare. Once those 5 sessions are done, it gets billed privately and it doesn't contribute to OOP costs for medicare.

 

I have a big issue with management plans only covering such a small amount of sessions when complex medical conditions (which is what the plans are for) can't be successfully treated in 5-10 sessions depending on what plan you're on.

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born.a.girl

Yes, this is correct. E.g. I have a CDMP for 5 sessions with my Osteopath which gets billed under medicare. Once those 5 sessions are done, it gets billed privately and it doesn't contribute to OOP costs for medicare.

 

I have a big issue with management plans only covering such a small amount of sessions when complex medical conditions (which is what the plans are for) can't be successfully treated in 5-10 sessions depending on what plan you're on.

 

 

Ridiculous isn't it, when those five are over all areas.

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lizzzard

OP I don't want to give you false hope but new (increased) support for psych services only just took effect - I think around December 2019? So it might be worth giving the APS a call to ask their opinion on your situation.

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BusbyWilkes

I think only for certain diagnosis? I know eating disorders are now covered for more sessions, as scientific evidence shoes they need very regular input to make any change (which is probably the same as all diagnosis really, but the evidence and advocacy was strong from this group).

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