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Psychiatric services can include treatment for conditions like mood and personality disorders, eating disorders, addiction and other mental health issues. In Australia, private health funds are legally obligated to offer cover for in hospital treatment and you can also get cover with Medicare, though certain rules and restrictions apply.
Medicare offers cover for some hospital psychiatric treatment, but only up to certain limits and under certain conditions.
Medicare will cover costs related to diagnosis, focused psychological strategies, some medications and treatment assessments as long as they are connected to clinically diagnosable disorders that significantly interfere with a person's cognitive, emotional or social abilities. Keep in mind that health professionals set their own fees, which means Medicare may only be able to cover some, but not all, of the costs.
All health funds will cover psychiatric care costs in their hospital policies. This is generally referred to as a restricted benefit which means that no matter what level of hospital cover you have, it will pay a benefit towards the cost of being treated as a private patient in a public hospital. Additional out-of-pocket expenses you may incur can include:
If you want psychiatric care with no restrictions, gold tier hospital cover is the only tier that must offer full cover.
Both Medicare and private health insurance provide different services for mental health services. Keep in mind that waiting times apply.
Inpatient care comes under hospital cover as it requires you to check into a mental health facility to be in the direct care of medical professionals. Treatments can include therapy, addiction treatment, psychological evaluation and other inpatient services. By April 2020, all gold tiered policies will offer inpatient psychiatric care.
Medicare, on the other hand, will cover you for treatment in a public hospital if you require hospitalisation for mental health care. As stated previously, this includes up to ten individual and ten group sessions of psychiatric treatment per year.
Private health insurance generally won't cover you for out of hospital psychiatric services. While psychiatric services won't be covered, comprehensive extras policies often give you access to therapy or counselling sessions with a psychologist without the need for a referral.
Appointments with a private psychiatrist outside a hospital are generally not covered by private health insurance - you will need Medicare for this.
However, private hospital insurance can cover psychiatric treatment for inpatient services. Cover generally includes paying for the cost of hospital accommodation and a portion of the medical fees. Services can include help for psychiatric, mental, addiction, behavioural disorders and more.
You can get cover on a restricted basis with basic, bronze and silver policies - meaning you will have out of pocket expenses - or you can get comprehensive cover with a gold policy with little or no additional expenses. Keep in mind that policies which provide cover on a restricted basis may not cover much of the costs of hospital treatment as a private patient.
Looking for the right policy can be tricky. Here are some things worth looking out for that'll make searching easier.
When it comes to getting the mental care and psychiatric support you need, there are several places and resources that could help:
If you're ready to look for a policy, you can pop your details into our easy-to-use search engine. Our handy tool lets you compare loads of health providers side by side to ensure you're getting the services and benefits you need.
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Hi,
Im looking for a health fund that covers Mental health private hospital care,
Hi Janene.
Thanks for your question.
You may compare mental health insurance options by simply filling-in the e-form on this. Kindly note that not all policies provide full coverage and there may be a difference between what is covered and what you will have to pay yourself, so please make sure to check the policy’s terms and conditions and PDS carefully before purchasing to ensure you have the cover you need.
I hope this has helped.
Cheers,
Liezl