Fees

Make the most of your family safety net.

• Ensure you have the right type of referral for neurodevelopmental assessments or psychometric tests.
  • These allied health services usually require a paediatrician or psychiatrist referral to be eligible for Medicare.
• Get the whole family sorted.
  • Check whether any medical expenses for other family members are eligible for Medicare. There are Medicare schemes for eating disorders, chronic diseases, mental health, and more. Any gap fees you pay will then contribute to your safety net.
• Your family’s safety net will reset at the end of each calendar year, so be strategic in your decision making. For example:
  • if you’re unlikely to benefit from the safety net this year, it might be better to delay expensive assessments to the start of the following year.
  • if you’ve reached the safety net this year, but perhaps don’t think you will the following year, try to get as much done as you can before the years’ end.

Eating Disorder Treatment and Management Plan (EDP)

An Eating Disorder Treatment and Management Plan (EDP) allows eligible people to access Medicare rebates for the following services over a 12 month period.

• up to 40 sessions of evidence-based psychological treatment from a mental health professional. This can include individual and/or group session
• up to 20 sessions of dietetic services from an Accredited Practicing Dietitian (as recognised by Dietitians Australia)

Getting an EDP involves a formal assessment from your GP, paediatrician or psychiatrist, during which they develop a written plan for your eating disorder care.

Your doctor will need to determine if you are eligible for an EDP. Most people with Anorexia Nervosa, and some with Bulimia Nervosa, Binge Eating Disorder or Other Specified Feeding and Eating Disorders (OSFED), are eligible. Those with Avoidant Restrictive Food Intake Disorder (ARFID) are not typically eligible.

Eating Disorder Treatment and Management Plan Review (EDR)

If you need more than 20 allied health sessions in a year, your EDP must be reviewed to continue receiving Medicare benefits. This involves discussing progress with you and your team, deciding what is and isn’t working, and plotting a new path forward. These reviews must be performed by either a psychiatrist or a paediatrician / adolescent medicine specialist.

If you are eligible, Medicare will contribute some money to help you pay for medical appointments. At WYC, you pay the full amount first and then we submit your claim to Medicare for you. If approved, Medicare will then deposit money into your nominated account (or that of your parent or guardian), so make sure your bank and address details are up to date with them.

Your out-of-pocket cost (‘gap fee’) is the difference between the fee charged by your doctor and the amount that Medicare pays you. If your family spends a certain amount on gap fees, they may reach the ‘safety net’ (see below) after which Medicare contributes more money towards appointments.

To see a specialist doctor and receive Medicare benefits, you will need a referral letter from your GP. These usually last about a year before they expire. You will also need a Medicare card (or access to your family’s Medicare card).

Common MBS items

Medicare also helps with allied health appointments but only if you can access one of the schemes listed below. There are limits on the number of allied health sessions Medicare will pay for and gap fees usually apply. Allied health includes disciplines such as psychology, occupational therapy and physiotherapy.

• Chronic Disease Management Plan: up to 5 allied health services each year
• Mental Health Treatment Plan: up to 10 mental health services each year
• Complex Neurodevelopmental Disorders & Eligible Disabilities: up to 8 allied health services for diagnosis and 20 services for treatment.
• Eating Disorder Treatment & Management Plans: up to 40 psychological services and up to 20 dietetic services per year.

The Extended Medicare Safety Net provides extra funding for families who need more support. Once a family spends a certain amount on gap fees, Medicare will pay 80% of each gap fee for any family member for the rest of that calendar year. For most families, the safety net kicks in at about $2400, but it can be lower (about $770) in some circumstances. Families need to register to access the safety net.

The NDIS is separate to Medicare. If you have a disability and are eligible, the NDIS may pay for a range of services, including treatment from allied health clinicians. It does not usually pay for doctor’s visits.

Private health insurers are not allowed to cover doctor’s appointments outside of hospitals, but they may assist with allied health services.

You or your family may be eligible for financial assistance from Centrelink, such as carer’s allowance or carer’s payment.

• Adolescent Medicine: The Perth Children’s Hospital
• Sexual Health: Sexual Health Headquarters
• Drugs and Alcohol: Drug and Alcohol Youth Service
• Mental Health: Crisis Connect, Headspace
• Family Therapy: Roxanne Garven Family Therapy, Williams Street Family Therapy
• Other youth services: Youth Services Directory