Bupa Health Insurance

Bupa Health Insurance

From 1 April 2022, eligible Bupa members can claim benefits for services delivered by Accredited Mental Health Social Workers.

 

Bupa members holding relevant Extras Cover can receive benefits for mental health services provided by Accredited Mental Health Social Workers, who are working in private practice and have a Medicare provider number.

Benefits can be for initial, subsequent and group therapy sessions in person or online.

A referral is not required for these services to be eligible for a rebate.

Bupa defines Private Practice as a practice operating on an independent and self-supporting basis, either as a sole, partnership or group practice but not under an agreement with, or the subsidy by, another party for the provision of accommodation, facilities or other services or practitioners. Practitioners in practice at Public Hospitals or any other type or class of publicly funded facility do not meet the guidelines of Independent Private Practice.

 

AASW members do not need to register with Bupa. As an AMHSW with a Medicare provider number, you are automatically recognised by Bupa. AMHSWs must continue to meet Bupa’s recognition criteria and comply with the Ancillary Provider Terms.

If you are currently not an AMHSW, please visit our website to check your eligibility to obtain this credential.

If you are an AMHSW in private practice and still need to organise a Medicare provider number, go to the Services Australia website to apply.

  • Focused psychological strategies provided face to face
  • Focused psychological strategies provided by teleconsultation

The primary intent of this recognition is to provide access to mental health services in terms of focused psychological strategies identified by Medicare. The types of services that would not be covered include:

  • attendance at court
  • travel time
  • cancellation fees
  • report writing
  • supervision

 

Bupa requires an official receipt or itemised account to be issued on letterhead with business logo or office stamp. There can only be one fully itemised original account/receipt, which must include the following as a minimum:

  • Provider’s address, contact details, ABN and the Medicare Provider Number
  • Full name of the practitioner who provided the service
  • Address where the provider performed the service (including if the service was delivered via Telehealth)
  • Patient’s name
  • Treatment/s provided including the industry-based item number/s and individual charge for each item
  • Date of the service
  • Whether the account has been paid.

Please refer to the Bupa Service Descriptors below (these are our industry-based item numbers). These must be included on receipts/accounts to ensure claims are accepted. Do not include Medicare item numbers or descriptions.

Clients can access allied health services under a variety of programs and initiatives which provide, in most cases, a defined number of services. These services can either be claimed from Medicare or the private health fund, but not both.

Initially, claims must be manually processed. These can be submitted through a few different channels:

  • posted into Bupa
  • dropped in at a Bupa Retail Centre or
  • submitted online via myBupa.

Claim volumes will be monitored for 12 months. When at an adequate level, Bupa and AASW can put forward a request to HICAPS to set AMHSWs as a new provider type. We will keep members up to date regarding this.

 

Social Work (psychological therapies) Initial Consultation

Social Work (psychological therapies) Subsequent Consultation

Social Work (psychological therapies) Couple or Family Therapy Y400 Social Work (psychological therapies) Group Consultation Y701 Social Work (psychological therapies) Individual Initial Referred Assessment by Teleconsultation Y801 Social Work (psychological therapies) Individual Subsequent Treatment by Teleconsultation Y802 Social Work (psychological therapies) Couple or Family Attendance by Teleconsultation

The Bupa rebate varies depending on the level of Extras Cover your client holds. Bupa members can check their individual coverage for mental health services by logging into myBupa. Yearly limits and waiting periods also apply according to the level of cover.

 

A maximum of one service per eligible Bupa customer, per provider, per day is payable. A maximum of one initial attendance per eligible Bupa customer, per provider is payable per 12 months.

For individual provider enquiries, contact Bupa’s Provider Operations on 1800 060 239.

Please note the details contained here are accurate as of 12 July 2022 and may be subject to change.