Obtaining a Referral
You may attend Exclusive Wellbeing as a Private Patient.
In most circumstances, you will not require to obtain a referral from your GP. However, to ensure best practices it is useful to have your GP involved in your health care where possible. All psychological services are able to be claimed through your private health fund, if you have the appropriate levels of Extras Cover. Please contact your health fund directly to estimate your exact level of cover for our services.
Referrals under Medicare
The Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (Better Access) initiative aims to improve outcomes for people with a clinically-diagnosed mental disorder through evidence-based treatment.
Under this initiative, Medicare rebates are available to patients for selected mental health services provided by general practitioners (GPs), psychiatrists, psychologists (clinical and registered) and eligible social workers and occupational therapists.
What Medicare services can be provided under the Better Access initiative?Medicare rebates are available for up to ten (10) individual and ten (10) group allied mental health services per calendar year to patients with an assessed mental disorder who are referred by:
- A GP managing the patient under a GP Mental Health Treatment Plan; or
- Under a referred psychiatrist assessment and management plan; or
- A psychiatrist or paediatrician
Allied mental health services under this initiative include psychological assessment and therapy services provided by clinical psychologists, and focussed psychological strategies services provided by appropriately qualified GPs and eligible psychologists, social workers and occupational therapists. Psychiatrists and paediatricians are able to directly refer patients with mental disorders for Medicare rebateable allied mental health services. Charges in excess of the Medicare rebate are the responsibility of the patient.
What are the eligibility requirements?
The Better Access initiative is available to patients with an assessed mental health illness or disorder, who would benefit from a structured approach to the management of their treatment needs. ‘Mental disorder’ is a term used to describe a range of clinically diagnosable disorders that significantly interfere with an individual’s cognitive, emotional or social abilities.
How can I access these services under Medicare?
Step 1: Visit your GP who will assess whether you have a mental disorder and whether the preparation of a GP Mental Health Treatment Plan is appropriate for you, given your health care needs and circumstances.
If you are diagnosed as having a mental disorder, your GP may either prepare a GP Mental Health Treatment Plan, or refer you to a psychiatrist who may prepare a psychiatrist assessment and management plan.
Alternatively, your GP may refer you to a psychiatrist or paediatrician who, once an assessment and diagnosis is in place, can directly refer you to allied mental health services. Whether a patient is eligible to access allied mental health services is essentially a matter for your treating health practitioner to determine, using their clinical judgement and taking into account both the eligibility criterion and the general guidance.
Some clients may choose to attend their first consultation at Exclusive Wellbeing for a Clinical Assessment and Diagnosis, which can then be provided to your GP to obtain a Mental Health Treatment Plan.Step 2: You can be referred for certain Medicare rebateable allied mental health services once you have:
- a GP Mental Health Treatment Plan in place; or
- are being managed by a GP under a referred psychiatrist assessment and management plan; or
- been referred by a psychiatrist or paediatrician.
Your GP or psychiatrist/paediatrician can refer you for up to six individual or six group allied mental health services, which may comprise both psychological assessment and therapy by a clinical psychologist, or focussed psychological strategies by an allied mental health professional.
Step 3: Depending on your health care needs, following the initial course of treatment (a maximum of six services), you can return to your GP or psychiatrist/paediatrician and obtain a new referral to obtain an additional four sessions to a maximum of ten individual and ten group services per calendar year.
Whether you have a clinical need to access the additional allied health services which attracts a rebate is a decision for your treating health practitioner, taking into account the written report received from the allied mental health professional at the completion of a course of treatment. At this time, a review of your GP Mental Health Treatment Plan may also be undertaken.
From 1 January 2013 the number of individual allied mental health services for which a person can receive a Medicare rebate will be ten services per calendar year. Exceptional circumstances apply when there has been a significant change in the patient’s clinical condition or care circumstances which necessitates a further referral for additional services. It is up to the referring practitioner (e.g. GP) to determine that the patient meets these requirements. A Fact Sheet providing more detailed information on the arrangements for accessing further allied mental health services under exceptional circumstances can be found at: http://www.health.gov.au/mentalhealth-betteraccess.
Employee Assistance Program (EAP)
An Employee Assistance Program (EAP) is a work-based intervention program designed to enhance the emotional, mental and general psychological wellbeing of all employees and includes services for immediate family members. The aim is to provide preventive and proactive interventions for the early detection, identification and/or resolution of both work and personal problems that may adversely affect performance and wellbeing. These problems and issues may include, but are not limited to, relationships, health, trauma, substance abuse, gambling and other addictions, financial problems, depression, anxiety disorders, psychiatric disorders, communication problems, legal and coping with change.
If your employer does not offer EAP services, they may agree to pay for psychological interventions by a private provider such as Exclusive Wellbeing. You will be required to discuss your needs with your HR department or Return to Work Co-Ordinator to ensure that they will cover the cost of therapy.
EAP services are often brief interventions and your Employer does not have access to any direct information regarding your confidential information. Employers occasionally may request information regarding your ability to perform your duties. However, this would only occur if there were concerns regarding your current performance at work and ensuring that you are fit to complete the responsibilities of your role at work.
If you have sustained an injury at work or relating to your employment, you may be eligible to make a claim through WorkCover NSW. Once you have made a Worker’s Compensation claim, you will receive a claim number. Please ensure that your claim for psychological services has been approved prior to attending Exclusive Wellbeing. Claims which are not approved will not be paid by the Insurance Company and you will be liable to cover the costs of your treatment at the Medico-Legal Rates listed in our Fees section.
If you have sustained a psychological injury secondary to an insurable event (e.g. Motor Vehicle Accident) or other stressor (e.g. Crime), you may be eligible to receive psychological therapy to assist with coping following the incident. Please check with the relevant party (e.g. CTP insurance, Department of Veterans Affairs) if you are able to obtain these services. We are able to assist with your difficulties, but it is important that you are treated under the appropriate program.
Referrals for Medico-Legal purposes are often made directly through your legal representative. They will be able to identify the key purposes of the assessment and reporting in order to ensure that the appropriate services are provided. Medico-legal assessments may assist a court or other fact finder in arriving at a just or correct decision. At Exclusive Wellbeing we have expertise in medico-legal reporting which may assist in a wide variety of civil and criminal matters. Civil matters include, but are not limited to, lawsuits and insurance claims where emotional or psychological suffering is part of the claim, determination of competency of an aged or ill person to make decision, and a variety of other areas. In addition to expert medico-legal assessments and reports, we can provide evidence-based psychological treatment whenever this is recommended by the courts.
AssessmentsWe offer diagnostic and psychological assessments to determine the extent of psychological injuries. Our assessments measure a client’s current functioning to determine the extent to which the individual is experiencing psychological distress resulting from various disorders. The assessments can include an estimate of impairment from previous levels of functioning and possible future prognosis of impairment levels. Psychological distress may result from a number of disorders including:
- Anxiety Disorders
- Mood Disorders
- Adjustment Disorders
- Panic Disorder
- Post-Traumatic Stress Disorder (PTSD)
- Grief and Loss
- Chronic Pain
Medico-Legal ReportsWe can arrange a broad range or Psychological Assessments and Psychological/Psychiatric Reports. Psychological/Psychiatric assessments and reports are often sought when a third party (e.g. Insurance Company) wishes to obtain a formal diagnosis or report including:
- Psychological Court Reports
- Medico-Legal, Injury and Compensation Assessments
- Risk Assessments
- Independent Assessments
Expert WitnessOur experienced team of clinicians provide expert witness in and for court on a variety of legal matters. These may include:
- Drink driving offences
- Assault and/or other violent offences (for the defendant or victim)
- Personal Injury Claims
- Motor Vehicle Accident Claims
- Work Injury Claims
- Relationship break-down and divorce settlements
- Custody disputes
Please contact us directly to discuss your needs.