Bupa FAQs

What’s changing and when

From 1 July 2018 Bupa will offer benefits for counselling services provided by practitioners who meet Bupa’s recognition criteria. Benefits for these services will fall under the category called “Mental Health” in a number of Bupa’s Extras Products.

Frequently Asked Questions

  • Which providers will have benefits payable for counselling services?
    Benefits will only be payable for practitioners in private practice who meet Bupa’s provider recognition criteria for counselling services. In relation to provider recognition by Bupa for the purposes of paying benefits for counselling services, the use of the term “counselling” is understood to include “psychotherapy”. Bupa’s recognition criteria will be available on bupa.com.au on or before 1 July 2018.
  • How do I know if I meet Bupa’s recognition criteria for counselling services?
    Check with your Association to see if you meet Bupa’s recognition criteria. If you wish to be recognised by Bupa so that your clients can access benefits for your services, your Association will provide Bupa directly with your details.
  • Will I be issued with a provider number?
    Bupa will issue a provider number for your practice location. If you practise in more than one location, a separate provider number will be issued for each location. You can register up to 4 provider locations with Bupa unless we otherwise agree in writing.  You should notify your Association if there are any changes to your practice address/es.
  • Does my provider number have to appear on my invoices and receipts?
    Your Bupa provider number/s should be either printed or stamped on your official invoices and receipts.
  • What services are claimable through Bupa for counselling services?
    Bupa pays benefits on an attendance basis. For counselling services provided by a Bupa recognised practitioner, a benefit is payable for one attendance, per member, per day, in accordance with the Bupa member’s product entitlement, yearly limits and Bupa’s fund rules.Services claimable are as follows and invoices/receipts should be issued with the appropriate service description (as below) for the service provided to the Bupa member.

    Service Description

    • Initial attendance – please note – a maximum of one initial attendance is payable per member, per provider, in a 12 month period
    • Subsequent attendance
    • A couple or family attendance
    • Group attendance
  • Do I have to include an item number on the invoice/receipt as well as the service descriptions?
    It is not mandatory to include the item number on the invoice if the description of the service is clearly stated. Different private health insurance funds will use different item numbers.  If you chose to include the item number as well as service description, the relevant Bupa item numbers are listed below for your reference.
Item Number Service Description Notes
J100 Initial attendance A maximum of one initial attendance is payable per member (per provider), in a 12 month period
J200 Subsequent attendance
J300 A couple or family attendance
J400 Group attendance
  • Why is there a rule around initial attendances and when can I bill an initial attendance?
    Bupa has certain business rules that govern the way claims are paid. Bupa would expect to be billed for an initial attendance in the following circumstances:

    • when a new client commences treatment
    • when an existing client starts a new course of treatment for a different condition to that previously addressed with counselling
    • when an existing client has had a break in counselling for an extended period of time (over 2 years) and then recommences treatment
  • Are the same service descriptions and item numbers used regardless of whether psychotherapy or counselling services are being provided?
    Yes. As a Bupa recognised provider, we understand that a range of different modalities may be used when working with a client. For the purposes of paying a benefit, Bupa will refer to all services provided by recognised providers under the banner of “counselling services” as “counselling”. Irrespective of whether the practitioner may consider the service provided to be “psychotherapy” or “counselling”, the appropriate service description from the list above should be used to describe the service provided at each attendance.
  • Can I claim for Skype consultations or consultations provided by telephone?
    No. Bupa will pay benefits only for the provision of counselling services directly to a Bupa member. The Bupa member and the practitioner must be in the physical presence of each other when the treatment session takes place.  This is currently Bupa’s policy for all Allied Health services for which it pays benefits.
  • Can I claim for the writing and provision of a report or assessment requested for medical or legal purposes?
    No. Bupa will pay benefits only for the actual provision of counselling services directly to a Bupa member. No benefits apply to the preparation and provision of reports and assessments.
  • Will payment for these counselling services be available through point of service claiming technologies such as HICAPS or CSC HealthPoint?
    No. Bupa members will need to submit their claims to Bupa by mail, at a Bupa Retail Store or online via MyBupa.
  • Will all Bupa products pay benefits for counselling?
    Benefits for counselling services will only be paid for members on the appropriate level of extras cover. Extras covers include benefits for services that are not inpatient/hospital services, many of which are delivered by allied health providers.
  • What should I tell a Bupa member who queries how much they’ll get back from Bupa for a service?
    There are a number of factors that can affect what benefit is payable, including the product the member is on, waiting periods, and yearly limits. We recommend that the client should contact Bupa directly on 134 135 to determine their benefit entitlements.