Is counselling covered by my health insurance
With the living costs in Australia increasing you may be thinking “is counselling covered by my health insurance?”
At this stage there is no ‘one-fits-all’ answer.
Times are changing and our understanding of wellbeing is growing. We are seeing a significant rise in the recognition of mental and emotional health by private health insurance providers.
Traditionally most insurance plans have acknowledged the role psychologists and psychiatrists play, however after the global pandemic and the impact on mental health, some providers are extending their reach to include rebates for counselling as well.
If you have are wondering “is counselling covered by my health insurance” you are not alone. At this time the answer is not a ‘one-fits-all’ and will likely require some research or a conversation with your health insurance provider.
In this article we will discuss:
- What is health insurance and what does it cover
- What is covered under a counselling session
- What qualifies counsellors as a provider for health insurance rebates
- How to check if my insurance covers counselling
- How do I claim a counselling session on health insurance.
What is health insurance ?
Health insurance is a safety cushion for your well-being that can provide support during uncertain times and ease the financial pressure in seeing health practitioners to keep yourself functioning well.
It’s a contract between you and your health insurance provider where you pay a regular fee (weekly, monthly, quarterly or annually) in exchange for coverage of a wide-range of medical expenses.
What does health insurance cover?
What your health insurance covers is largely dependent on your provider and the specific plan/policy you have signed up for. You can usually opt for hospital and/or extras cover.
- Hospital cover will pay for some or all of the costs associated with treatment in public or private hospitals – as a private patient with the doctor of your choice.
- Extras cover will pay for some or all of the costs associated with health services that are not covered under Medicare such as physiotherapy, psychology, dental and optical.
How does health insurance work in Australia?
According to a Forbes Advisor article in August 2022 “What is Health Insurance and How Does it Work In Australia?” over half of Australians have private health insurance.
It simply begins by taking out a policy with your preferred insurance provider (best to do your research here) and paying regular premiums to them. When you need to access medical treatment (that is not covered under the public Medicare system but is covered by your provider) your provider will pay for all or part of the costs involved.
The amount covered will depend on how long you have been with your insurance provider and the terms of your policy. Some will have certain waiting periods and limits stipulated in your policy for different treatments. For example you may not be able to claim benefits for the first 2-6 months on some treatments or you may have an annual limit on some treatments.
When paying for treatments covered by your health insurance, you will either:
- pay the costs upfront and send in a claim for reimbursement
- handover your health insurance card to be swiped on a HICAPS machine and pay the out of pocket cost.
It’s important to note that out-of-pocket costs are usually around 40-50% of the fee, although some providers are more generous and will pay 80-100% of the cost. It is always best to check your policy first and check if your healthcare provider has a HICAPS machine.
And lastly, do your research and consider your needs so that you can find the best policy and value for money that suits you/your family.
What is covered under a counselling session?
What is covered under a counselling session is between you and your practitioner. As long as your preferred counsellor meets the requirements of your health insurance provider, no referral is needed (unless otherwise noted in your policy).
At this stage couples counselling is not covered under most standard health insurance plans as it is not deemed ‘medically necessary’ (although some would argue this point). However it is always good to check with your provider or practitioner.
How do I know if my counsellor is a registered health insurance provider?
There have been some changes in 2023 and counselling may be covered by your health insurance provider. The easiest way to find out if your counsellor is a registered health insurance provider is simply by asking.
Most health insurance providers will ask that they are a member of at least one of the following mainstream professional organisations:
- Psychotherapy and Counselling Federation of Australia
- Australian Counselling Association
- Australian Traditional Medicine Society
They may also need to meet certain requirements – dependant on the health insurance provider. This can look like:
- Ancillary billing standards
- Patient record standards
- Educational requirements
- Minimum client contact experience
Psychologists, nurses, social workers and occupational therapists are also generally able to offer counselling (talk therapy) that can be claimed through health insurance. Again it’s best to just ask the question of both your preferred counsellor/practitioner and your health insurance provider if their services are covered.
How do I claim a counselling session on health insurance?
There are two ways to claim a counselling session on health insurance:
- Pay the full fee and send the receipt to your health insurance provider who will reimburse you for the amount they cover.
- If your counsellor has a HICAPS machine, they will be able to process your health insurance card, leaving you to pay the out-of-pocket fee.
How to check if my health insurance covers counselling
To check if your health insurance covers counselling, simply check your policy including waiting periods and limits. Some health insurance providers will have a database of recognised counsellors available on their websites.
If your preferred counsellor is not listed, simply ask them if their sessions are covered by your health insurance provider.
There is a lot to consider when it comes to health insurance and finding the right policy and provider that fits your needs and budget. With Australia’s public healthcare system being free, some will find health insurance a luxury that they just can’t afford, whereas others can’t afford to be without it.
When it comes to counselling sessions being covered by your health insurance provider it’s simply a matter of asking the question. At this stage, it can limit your options particularly in the holistic therapist field. If your preferred counsellor isn’t covered then you will need to decide how important this is to you and your budget.
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