Medicare rules blow out wait times to see a psychologist and costs to $4000

Bureaucratic Medicare rules are standing in the way of Australians getting immediate care and are costing patients $4,000. Have your say.

Exclusive: Hundreds of thousands of patients desperate for mental health care are being denied Medicare rebates to see a psychologist under “stupid” bureaucratic rules.

The rules are costing patients up to $4000 a year and driving up taxpayer funded health costs under Medicare.

They are also stopping patients from accessing new telehealth services that could slash the six month wait to see a psychologist down to less than 24 hours.

Mental health problems have soared in the wake of Covid with one in three psychologists unable to see new clients and patients waiting more than six months to get help.

In 2022, patients are entitled to up to 20 Medicare rebatable services with a psychologist provided they have a mental health care plan drawn up by their GP referring them for care.

But long wait times to see a GP are delaying access to psychological help and the Australian Psychological Society wants people to be able to access the first few sessions with a psychologist without a mental health plan.

“Getting patients to psychologists faster by no longer requiring a referral for the first three sessions for the next 12 months is common sense and a win-win for everyone,” said APS President Tamara Cavenett.

Medicare rules hampering access to telehealth psychological care. Picture Getty Images

Under another bizarre anomaly, even if a patient has a mental health plan but it is drawn up by a GP in a consultation that does not attract a Medicare rebate they can’t get a Medicare rebate when they see the psychologist.

The problem has come to light with the arrival of new telehealth GP services where patients are billed privately for a GP consultation.

InstantScripts charges patients $49 for a telehealth consultation with a GP but the service does not operate under the Medicare system and patients can’t claim a Medicare rebate for the service.

When a GP working for InstantScripts draws up a mental healthcare plan for a patient and refers them to a psychologist, Medicare does not recognise the plan because no Medicare rebate was ever paid.

As a result when the patients see the psychologist they have to pay the entire bill, which could amount to between $180 and $300 per session and they will get no Medicare rebate.

InstantScripts founder Dr Asher Freilich has described the rule as “stupid” and is calling for it to be changed.

“We don’t want to get paid $1 from Medicare. We just want our patients to get funded access to psychology services,” he said.

Online psychology provider MyMirror which has a group of more than 60 clinical psychologists said if the rules changed people could do a telehealth consult with InstantScripts in the morning and be talking to one of its 60 telehealth psychologists in the afternoon.

“Every politician and every mental health advocate in the space is harping on about wanting new solutions but we don’t need sexier solutions, we need fixes for the simple problems,” My Mirror founder Dr Matthew Zoeller said.

The Minister for Health and Aged Care Mark Butler said telehealth was not suitable for mental health diagnosis Picture: NCA NewsWire / Martin Ollman

Health Minister Mark Butler is refusing to consider the proposed changes and said a Medicare review had found telehealth was not suitable for mental health diagnosis.

“That is why under the MBS, the initial consultation to consider a diagnosis of a mental disorder and developing a treatment plan must be conducted through face-to-face and video consultations only, rather than over the telephone,” he said.

Royal Australian College of General Practitioners (RACGP) president adjunct professor Dr Karen Price said “allowing people to bypass their GP to access Medicare-subsidised psychologist sessions is not the answer”.

“What might appear to be depression can be something else entirely such as incipient dementia or hypothyroidism,” she said.

Around 50 per cent of patients with mental health issues also have additional chronic disease problems, she said.