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.  Your 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. The Provider Number can only be used at the nominated practice address, if you change practice address you must contact PACFA immediately to apply for a new provider number.

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?

Medibank rebates for counselling are only available to Medibank members with appropriate policies. To make a claim, members must have a policy with the package bonus or membership bonus feature.

The following Medibank product includes a “membership bonus” and is currently available for purchase:

  • Medibank Silver Plus Families

The following products include a “membership bonus” but are no longer available for purchase:

  • Silver Plus New Family Essentials (previously called New Family Essentials)
  • Silver Plus New Family Comprehensive (previously called New Family Comprehensive)
  • Silver Plus Everyday Comprehensive (previously called Everyday Comprehensive)
  • Silver Plus Settled Families Comprehensive (previously called Settled Families Comprehensive)
  • Silver Plus Security Comprehensive (previously called Security Comprehensive)
  • Settled Family Essentials

The following Medibank Private products include package bonuses that can be used for counselling, but are no longer available for purchase:

  • Gold Premier (previously called PremierPlus)
  • Gold Advantage (previously called AdvantagePlus)
  • Silver Plus Smart Options (previously called Smartplus)
  • Bronze Plus Healthy Options (previously called HealthyPlus)

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 “package bonus ” or “membership bonus”. The maximum customers can have in their package bonus accounts is $100 per year for a Single membership which can be accumulated up to a maximum of $500. For a family it is $200 per year which can be accumulated up to $1000 (it takes 5 years to accumulate the maximum amounts). Theoretically, if a member had $500 in their account and they presented a Counselling account for $100, Medibank would pay the whole $100, meaning the client could access up to 5 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 off line, on-line claims are not currently available for making package bonus or membership bonus claims.  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 or call the Medibank Call Centre on 134190.

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 or accumulated bonus.

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 providing the same service, no.

To download the Medibank Private FAQs, click here.

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