Referral & Medicare & Private insurance

[Suncy]

Hi everyone, 

I'm just new here due to eating disorder issues. 

My GP referred me to a psychologist under MHCP. However the issue is, I need to wait too long for that psychologist, and then I need to change another. I was told if want to be eligible for MHCP, and covered by Medicare, on my referral letter, have to be with the correct psychologist name?

Also, my current fees plan is, running out my private insurance first (500 max), and then start to use Medicare. Is that okay?

Thank you everyone. 

Really appreciate. 

[Croix]

Dear New Member~

I'm sorry to hear you have an eating disorder, it can make life very difficult.

Just wondering if you have been in contact with the Butterfly Foundation, which offers advice and information on this matter (my apologies if you have thought of this already).

It is quite possible ot change psychologists whist in a MMCP, and is normally just a matter of your referring GP issuing  another referral. You have a good reason and it is simply a matter of if the GP approves of the new psychologist.

It looks a little hard to understand if you need to exhaust private insurance before claiming medicare or instead use it after your 6/10 sessions have run out, I'd suggest talking to you health  insurer to find out.

Croix

[Suncy]

Hi Croix,

Thanks a lot.

Just clarify, I feel it's a question regarding Medicare not my private insurance provider. Since my plan is, for example, for the first 6 sessions, I will claim only from my private insurance. And now I used up my private insurance limits. Okay now I will have to use Medicare, and my one round of consultation let's say, 10 sessions in total. And from the 7th session in that round, can I still back to Medicare to claim if you know?

Thanks,

Suncy

[Eagle Ray]

Hi Suncy,

If I understand correctly, you are planning to use your health insurance rebate for the first 6 times you see a psychologist and then go to the Medicare option for further sessions after that.

I don’t think it matters what order you do things in, so you could use private health or the Medicare rebate first. If you are concerned you want to see a psychologist sooner and preferred to use the Medicare rebate, you can certainly go back to your GP and get a different psych’s name on the referral. You may find you get more back on the Medicare rebate (depending on your health insurance).

After your first 6 sessions with the Medicare rebate you can go back to your GP to be referred for an additional 4 sessions, making up a total of 10 for the year for the MHCP. These are independent of the health insurance sessions so you can still request the additional 4 sessions if you’ve only done 6 under Medicare.

If you have used those 10 there is also the option of doing an Enhanced Primary Care Plan with your GP that can give you another 5 sessions to a psych. The Medicare rebate for that is a bit less than the MHCP but still helps.

So I think it’s fine if you want to start with the health insurance option but maybe compare the rebates and see which one gives you the most benefit. If Medicare gives you more, you may want to do the MHCP first and other options later. Or perhaps you want to start the MHCP fresh in the new calendar year given this year is almost over. I’m not sure if the date of the GP referral has to be in the same year the MHCP is used so you might want to check that as well.

I hope that makes sense! All the best with everything.

Kind regards,

Eagle Ray

[Suncy]

Hi Eagle,

Thank you so much for your detailed explanation. I will check again and decide.

Thank you so much!

Kind Regards,

Suncy

[Eagle Ray]

You’re welcome Suncy,

I’ve always got my MHCP referrals early to the middle of the year then subsequently used up the 10 sessions. That’s why I’m not sure if you have a recent referral if it will carry through to next year if you haven’t used it yet. But if not it’s super easy for the GP to start it again from early next year. You can check on your next GP visit.

Take care and all the best!