Enhanced Primary Care Plan – Help with Psychologist Fees

Chronic pain can make kids feel pretty low.

Chronic pain can make kids feel pretty low.

If your child is in chronic pain they might benefit from regular visits to the psychologist.

These services might be accessed in several ways:

  • Referral to attend a PMH as an outpatient of the psychology department
  • Attending a private psychologist paid for by your private health fund.

As a general rule Medicare refunds do not cover psychology services.  However there is an exception that you might find useful when you get to the end of what your private plan covers or your child is no longer attending a hospital outpatient service.

The Medicare allied health and dental care initiative allows chronically ill children and teenagers who are being managed by their GP under an Enhanced Primary Care (EPC) plan access to Medicare rebates for allied health services.

This means that you can get financial assistance for psychologist services from Medicare once your doctor sets up an Enhanced Primary Care plan for your child which is clinically necessary.

The list of allied health services you can claim includes psysiotherapists, psychologists and dental services. To view or print a A4 brochure that sets who is eligal and what services can be accessed visit Medicare Rebates for Allied Health Services. This brochure is produced by the Department of Health and Aging.

Once your child’s Enhanced Primary Care plan  has been completed and lodged by your GP and approved by Medicare you then have an ECP In place.

As your child requires services you request a referral from your GP for that service and then claim most of the costs back from Medicare.  Your GP will need to approve that the service is necessary for your childs health.

To give you an example of what might be covered by the plan, Medicare will refund approximately 85% of the cost of :

Psychologists – 12 visits per year

If your child has a chronic condition and you need financial assistance with for councelling services this might be an option worth exploring next time you visit your GP.

Some Conditions
Mental health service provided to a person by an eligible mental health worker if:
(a) the service is provided to a person who has a chronic condition and complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under an EPC plan; and
(b) the service is recommended in the person’s EPC plan as part of the management of the person’s chronic condition and complex care needs; and
(c) the person is referred to the eligible mental health worker by the medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and
(d) the person is not an admitted patient of a hospital; and
(e) the service is provided to the person individually and in person; and
(f) the service is of at least 20 minutes duration; and
(g) after the service, the eligible mental health worker gives a written report to the referring medical practitioner mentioned in paragraph (c):
(i) if the service is the only service under the referral – in relation to that service; or
(ii) if the service is the first or the last service under the referral – in relation to that service; or
(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of – in relation to those matters; and
(h) for a service for which a private health insurance benefit is payable – the person who incurred the medical expenses for the service has elected to claim the Medicare benefit for the service, and not the private health insurance benefit;
– to a maximum of 5 services (including any services to which items 10950 to 10970 apply) in a calendar year

Fee: $57.55 Benefit: 85% = $48.95

Follow this link and scroll down to Mental Health Services for more detail. More information

Photo courtesy of frizztex at Flickr Creative Commons.