FAQs Medibank Private


Do Medibank Private Provider Numbers enable Registrants to work with GPs and Mental Health Plans?

No. This is a Medibank Private Provider Number, not a Medicare Provider Number.  PACFA is still campaigning to get recognition for counsellors and psychotherapists to deliver Medicare services under the Better Access scheme.

What are the rules and regulations for use of Medibank Private Provider Numbers?

Standard rules and regulations apply. The Provider Number is not to be given to someone else to use and, importantly, it should only appear on accounts for services relating to “counselling”.

I do counselling and psychotherapy. Can my clients claim for both counselling and psychotherapy?

PACFA’s Agreement with Medibank Private covers “counselling”. This is a generic term and covers any modality of counselling or psychotherapy provided by the Provider. It is important that your invoice or receipt says “counselling” to ensure the Medibank Private member can get a rebate.

Is there a protocol for billing?

All the information on the official invoice/receipt must be in English and must be clearly written if it is hand written. Any receipts that don’t have the above information will be rejected and no benefit paid.  The invoice/receipt should include:

  • Provider number ,name and address
  • Name of the Medibank Private member receiving the service
  • Date of service
  • Type of service provided.  This must be “counselling”. This is a generic term and covers any modality of counselling or psychotherapy provided by the Provider.
  • Amount charged

Why do I have to have multiple Provider Numbers?

Medibank Private requires practitioners to have a separate Provider Number for each address where you practice.  You should use the correct Provider Number for the practice location where you see the Medibank Private member.

What is the option for mobile practitioners who visit client's homes?

Medibank Private do not issue Provider Numbers for mobile locations. If you provide a service to a Medibank Private member at the member’s home, you should use the Provider Number for your principal place of practice.

Can the Provider Number be used with HiCaps?

No. Medibank Private advise that the HiCaps service cannot currently be used for counselling services.

Who can make a claim?

Only Medibank Private members with relevant policies will be eligible for counselling rebates.  Rebates can be claimed as part of the “bonus package” available to approximately 1.6 million policy holders.  Only members with this type of policy can make a claim for counselling.  Members on Medibank Private’s PremierPlus, AdvantagePlus, Smartplus and HealthyPlus (and VIP corporate equivalents) products have access to the “bonus package” feature which they can use to claim for counselling.  PACFA continues to liaise with Medibank Private’s product development division to advocate for greater prominence for counselling in their health insurance products in the future.

How much can clients claim on Medibank?

Rebates can be claimed as part of the Medibank Private “bonus package”. The maximum customers can have in their bonus accounts is $500 for a Single membership and $1000 for a family (it takes 5 years to accumulate these levels). Theoretically, if a member had $1000 in their account and they presented a Counselling account for $100, Medibank would pay the whole $100, meaning the client could access up to 10 fully paid counselling sessions.

How do clients claim their Medibank Private rebates?

If a Medibank Private member is eligible for a benefit, they should submit their claim through the normal channels that members are aware of.  When making a claim, clients should say “I want to use my package bonus”. If they have any difficulties making a claim, they should ask to speak to the Manager of their Medibank Private retail branch.

Can Family Therapists claim Medibank rebates?

Yes, as long as the Provider is providing counselling to eligible members of Medibank Private. Medibank Private only pay benefits for counselling when provided to eligible members.

Can clients get rebates for the 8-week Mindfulness-Based Stress Reduction course?

No. This is not considered counselling.

What are the protocols/guidelines as to how the Provider Number can be used in advertising?

  • Provider Numbers should not appear in any advertising as this could lead to fraudulent activity.
  • Advertising can only indicate that Private Health Fund rebates may be available.
  • Providers can only say that “eligible Medibank Private members may be entitled to a benefit”. Not all Medibank Private products pay benefits for counselling and it is important not to create an expectation of a benefit if the member does not have the right level of cover.

Can I use the Medibank logo on my stationery?

No. The Medibank logo is not to be used in advertising at this point in time as it may create an expectation of a benefit if the member does not have the right level of cover.

If someone has a Provider Number as a Psychologist do they need another one as a counsellor?

If they are doing the same service, no.

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