Medicare Referrals

No. A referral entitles you to receive a rebate from Medicare, but you can still see a psychologist without a referral.

A referral can be written by certain kinds of a doctor: a general practitioner (GP), a paediatrician, or a psychiatrist.

Your first step in seeking help should be talking to your doctor. If they feel it is appropriate, they will write you a referral to a psychologist.

Your referring doctor specifies a number of appointments for the referral to cover, up to a maximum of 6.

Most doctors will write an initial referral for 6 appointments, and then a second referral (if needed) for a further 4 appointments. This is because only 10 appointments can be claimed per calendar year.

There is no time limit on using a referral.

When you have reached the number of appointments specified in the referral, the referral ends. Medicare will not pay a rebate for any further appointments.

Your psychologist will write a letter to your referring doctor, updating them on your circumstances.

Your doctor can, at their discretion, write another referral. Once this has been done, future appointments can be claimed with Medicare again – up to the maximum of 20 per calendar year.

We can lodge a claim with Medicare on your behalf, or you can do it yourself.

To lodge a claim, we need:

• Your referral letter
• Your name as it appears on your Medicare card
• Your date of birth
• Your Medicare card number, including the individual digit next to your name

To lodge a claim for a minor under 18 years old, we need to list a parent or carer as the claimant. In this case, we also need:

• The name of the parent/carer, as it appears on your Medicare card
• The parent/carer’s date of birth
• The parent/carer’s Medicare card number, including the individual digit next to their name

If you would prefer to lodge the claim yourself, you can do this by:

• Using the my.gov.au website.
• Using the Medicare phone app.
• Visiting a Medicare service centre.

To lodge a claim yourself, you will need:

• Your Medicare card
• An invoice from us confirming the details of your appointment.
• Medicare requires that the invoice is marked ‘Paid’. We will email you this invoice after receiving payment.
• We will put your referral details on this invoice after receiving your referral letter.

It depends. Depending on some details of your referral, the rebate will be either $87.45 or $128.4. Please contact us if you’d like to clarify what level of rebate you’ll receive.

If you have reached the Medicare Safety Net threshold for the year, your rebate will be higher.

Medicare will pay you the rebate via bank transfer, usually within 1-2 days.

Medicare will use the bank account they have on record for you. You can update your bank account details with Medicare by:

• Using the my.gov.au website.
• Using the Medicare phone app.
• Visiting a Medicare service centre.

We recommend that you keep track of how many appointments you have had on your referral. It is the client’s responsibility to ensure their referral is valid.

As a courtesy, we will endeavour to inform you by email when the end of your referral is approaching, and when it has ended, however this may not always be possible.

If you would like to check how many appointments you have left, please call or email us.

You can also check your history of Medicare claims on my.gov.au. This is the most accurate source of information, as Medicare has access to information we do not.

Only 20 appointments can be claimed per calendar year.

The best way to check how many claims you’ve lodged this year is to contact Medicare. The most convenient way to do this is via the my.gov.au website.

Yes. Your ‘review’ referral does not need to be written by the same doctor that wrote your original referral.

If you were originally referred by a paediatrician or psychiatrist, a review can be completed by your GP, which you may find to be more convenient and less expensive.

No. Referrals can only be used for appointments that occur after the referral was written.

No. Some of our psychologists prefer to have separate appointments with parents. These appointments cannot be claimed under a child’s referral – only appointments that the child attends can be claimed under their referral.

Depending on your circumstances, you may wish to discuss with your GP whether it is appropriate to receive your own mental health care plan.

No. Medicare rules state that you cannot claim a private health rebate for a service where Medicare has paid a rebate.

However, you can use one or the other for different appointments. For example, people will often claim the Medicare rebate for the maximum 10 sessions per calendar year, and then use their private health insurance for any further appointments.

Depending on your level of private health cover, it is possible that your private insurer may pay a higher rebate than Medicare. We cannot advise what rebate your private insurer will pay – you will need to contact them.

Yes. Medicare allows for referrals written to one psychologist to be used for another, as long as they are unused.

However, if you have already partially used a referral letter (i.e. you have attended appointments and lodged Medicare claims with a different psychologist), you must get a new referral to see a new psychologist.