Does private health insurance cover mental health

Mental health issues might not be as easy to pin down as physical health problems, but this area is finally getting the recognition it deserves from both the public and private segments of Australia's healthcare system.

Between Medicare and private health insurance, it's possible to access a large portion of the services available, from counselling to psychiatric care, without breaking the bank.

Mental health refers to how you feel emotionally and psychologically and how you're able to weather the ups and downs of life. It covers all of the following:

  • Your mood
  • Your ability to make good decisions
  • How you behave
  • How you handle stress
  • How you relate to others

You can think of mental illness as a health problem that significantly affects any of the abilities mentioned above. According to the Black Dog Institute, a leading non-profit Australian mental health organisation, one in five Australians is living with a mental illness at any given time.

Mental health issues can range from a short bout of work-related stress, to debilitating schizophrenia. In addition, there is a lot of overlap between the types of illnesses. For example, it is common for someone with bipolar disorder to also suffer from depression.

It's no surprise that it's been tricky navigating the world of mental health care. Following are some common conditions that are treated within the mental health system.

Anxiety and depression

These two very common conditions can range from mild to severe. Your first stop if you need some help would be your GP. If your GP thinks your condition is manageable, they may prescribe one of a range of widely used medications and perhaps refer you to a psychologist for some therapy.

For more severe cases, you may be referred to a psychiatrist, who will have more experience than a GP in diagnosing mental illness and prescribing more specialised medication.

Except in the most severe cases, which often involve an underlying disorder besides the anxiety and/or depression, most of this will be outpatient treatment. It can generally be covered through the public healthcare system and a private health insurance extras policy.

Psychotic disorders

People with these disorders lose touch with reality and need specialised treatment even in less severe cases. Examples that come under this heading include schizophrenia and bipolar disorder. People with these symptoms are usually referred to a psychiatrist who is well versed in managing such conditions. Medication and psychological counselling are generally included in the treatment plan.

Sometimes these conditions can be treated in an outpatient capacity, and are covered by a mix of Medicare and a private extras policy. However, some cases can be quite severe and require in-hospital care. In these instances, Medicare and private hospital cover can help with the cost of inpatient treatment.

Stress and daily management

Sometimes people just get stressed out and need psychological treatment even though there is no underlying "illness" to speak of. Conditions in this category include those such as work-related stress and relationship problems.

In most cases, all that is needed to help with symptoms is a few sessions of therapy with a psychologist. You don't even need a GP for that. If you have a private extras policy, you can book straight into see a psychologist and a few sessions will be covered.

Substance abuse, eating and other behavioural disorders

Substance abuse and other behavioural disorders can be the result of low self-esteem, an underlying mental illness such as depression or merely physical dependence. In cases where a person's health is at risk, hospitalisation is the first step that would be taken. From there, medical professionals generally work with the patient to help them stop the unwanted behaviour. They then try to work out if there is an underlying mental illness, such as post-traumatic stress disorder (PTSD), bipolar disorder or depression.

Treatments can include in-hospital care, rehabilitation, support groups and therapy. A mix of Medicare, private hospital cover and/or private extras cover would be required to help cover these costs.

Trauma-related disorders

These disorders can occur when a past traumatic experience affects someone's mental health. Examples include post-traumatic stress disorder and postnatal depression. These conditions can include depression, anxiety and/or behavioural disorders, which can often be severe.

A GP might treat someone who presents with one of these complaints by prescribing anxiety/depression medication. They would then most likely refer the patient to a psychiatrist, who can then develop a course of treatment. Therapy and medication may be enough in many cases, but in more severe cases, hospitalisation may be necessary.

Mental health treatment sometimes requires a cocktail of treatments and medications. Luckily, there is a variety of professionals who are trained to treat various aspects of mental illness. These include:

  • General practitioners. This should be the first port of call for anyone needing help with a mental health condition. GPs can coordinate the treatment of mild mental issues by prescribing medication and/or referring the patient to a psychologist for therapy. For more serious cases, they may be referred to a psychiatrist for further diagnosis.
  • Psychologists. You would visit a psychologist for therapy or counselling. Psychologists can help with almost all mental issues, from the mildest conditions to the most severe. You can see them without a referral and without needing to be on medication.
  • Psychiatrists. These are medical specialists who have trained to diagnose and treat mental disorders. They take on more severe cases that a GP is not qualified to diagnose. Psychiatrists can prescribe specialised medication and lay out a treatment plan that may also include therapy.

In 2006, the Australian government launched the Better Access initiative, which gives people improved access to mental health treatments under Medicare. Section synonym

Under this initiative, anyone with a mental health issue is covered for up to 10 sessions with a qualified psychologist and psychiatrist. All that's required is that you see your GP first to get a mental health treatment plan.

If you require hospitalisation, Medicare will cover you for treatment in a public hospital.

Private health insurance can supplement any rebates you are entitled to from Medicare. It can cover you in two ways:

  • Inpatient psychiatric care. Currently, many insurers cover this service fully cover this service in their mid- to top-tier policies, but by April 2020, all policies labelled "Gold" under the government's new rating system will offer it. If you already have health insurance, you can upgrade to a policy covering psychology without having to serve any waiting periods. Treatments include therapy, psychological evaluation, addiction treatment and a host of in-patient mental health services.
  • Outpatient mental health cover. Most extras policies will cover you for a handful of therapy or counselling sessions with a psychologist, and you don't need a referral. This is the perfect complement to Medicare's outpatient services because this benefit does not cover psychiatry whereas Medicare does. If you have both, you can maximise the visits to whichever professional services you need.

Compare options for psychology sessions

You can find plenty of options for outpatient services that can help toward treatment such as psychology sessions. The below policies from Finder partners include rebates for psychology sessions.

lifestyle$250 (no wait period)$51.00
Core and wellbeing extras$300 (2 months)$51.07Go to Site
Vital Extras$250 (2 months)$56.35Go to Site

*Quotes are based on single individual with less than $90,000 income and living in Sydney.

Compare options for hospital psychiatric services

Hospital Gold
  • Depression, anxiety, shyness, panic, health anxiety and obsessive compulsive disorder (OCD).
$500$164.05Go to Site
Top Hospital Gold
  • Psychiatric, mental, addiction or behavioural disorders
$750$168.90

*Quotes are based on single individual with less than $90,000 income and living in Sydney.

Use the 'refine search' feature in your results to choose treatments that matter to you.

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In April 2018, the Australian government implemented some changes to the way private health insurance covers mental health treatments. They were designed to make it easier for people to get the in-hospital mental health treatment they need, including treatment for anxiety, depression, drug/alcohol addiction and other mental health issues.

Here are the two major improvements:

  • Easy upgrades. You can upgrade to a policy will full in-hospital psychiatric cover anytime you want, without having to fulfill a waiting period for that treatment. You can even do so up to 5 days after being admitted and you'll still be covered.

If you are experiencing mental health issues or suicidal feelings contact Lifeline on 13 11 14 or BeyondBlue 1300 224 636. If it is an emergency please call 000.