Help! Health Insurance for out-patient services

[TheBigBlue]

I’m meant to start DBT in a few weeks, the hospital called me yesterday saying I needed to increase my private insurance coverage for psychiatrict care.

I called my health insurer & got some info & an exorbitant quote. Then when they asked about my treatment they said they only covered in-patient stays, not out-patient.

I called the hospital back & they ensured me is was an out-patient service & to call my insurer back & ask for a policy that provides cover for outpatients.

So i ring back the health insurer to be told Medicare covers out-patient services, not private insurance.

Now my anxiety is through the roof & I’m lost.

so what are my options? Pay full cost for DBT? Claim through Medicare if possible?

Are their insurance companies that DO cover psychiatric care for outpatients????

im so stressed about it now I can’t even think straight😢

[golden82]

hi The Big Blue.

My understanding - and I might be wrong - but as I understand it... private health funds differ between them slightly and also within their are different tiers of cover. For eg gold, silver etc. And each of these tiers has inclusions/exclusions for cover. If you have top hospital and top extras - you are pretty well set for everything be it inpatient or outpatient. Although sometimes waiting times etc. But as you slide down in scale you start missing out on things. So it could be that you are covered as an inpatient, but not as an outpatient. I would ring again and confirm - maybe get them to email you a copy you can look over.

There is DBT as public. I think these are more at local public health centres and are usually bigger groups with long waitlists. But I think these would be free or low cost?? You would probably have to ring around and put your name down. Good luck.

[Croix]

Dear TheBigBlue

I'm afraid there is no easy answer, I have the top probate health insurance with all extras with a long-established large company.

I've recently had 2 out-patient operations, neither of which was covered by my health insurance

As best I understand if the matter is listed for a medicare payment private health insurances will not also cover it, even if there is a big gap payment.

The government ?explains? it this way

https://www.health.gov.au/health-topics/private-health-insurance/what-private-health-insurance-cover...

It may be hard to find exactly what is and what is not a an in-hospital treatment, for example some firms at top level cover at least part of chemotherapy. It is a complicated system and often the medical professional involved may know exactly what is covered.

Croix

[TheBigBlue]

Sheesh!

That was more stress than I needed! My anxiety gets really high if I have to ring people & ask questions.

2 phone calls to the hospital & around 4 to the insurance company & it’s finally sorted.....

[Croix]

Dear TheBigBlue~

It can be very stressful indeed and I'm glad you have sorted it out. Hopefully now you can put that problem out of your mind

Croix

[TheBigBlue]

Thanks Croix.

I have an interview with medical staff at the hospital tomorrow so am relieved the insurance is sorted.

If all goes well tomorrow I start DBT in Feb 👍

[Aunt Jobiska]

Hi!

It is true that private hospital insurance only pays for in patient services, and your treatment centre may want you to upgrade your hospital insurance so that inpatient psychiatric services is an option should you need it.

Private extras insurance does pay for psychology, but only after the MHCP runs out - usually. You can't claim psychology from Medicare and health insurance at the same time. Occasionally private extras might also cover counseling from someone else. They may offer a small group rebate.

I have top health cover, but the gaps can still be huge. They also don't cover psychiatrists. Hope that might have helped.

[mirjanamia]

Hope you managed to solve the issue. If there's anyone esle looking for more tips, here are a few.
One option is to check if your out-patient services are covered under Medicare. You can contact your local Medicare office or speak with your healthcare provider to find out more information.
Another option is to look into private insurance companies that do cover psychiatric care for out-patients. It may take some research and phone calls, but it's worth it to find a plan that works for you.