Private health insurance and mental health (Australia)
Australian public hospitals are particularly good. But they do face challenges with the number of people currently seeking help for mental health problems.
This means you may need to go to a private hospital, especially if you need non-emergency treatment.
Private hospital stays can cost up to A$700 per day, and might be 2–3 weeks long.
Private health insurance will help you pay for this, provided you have the right level of cover.
This can be tricky though - more than half of the health insurance policies on offer in Australia do not provide adequate cover for a stay in a private psychiatric hospital.
Carefully check what your policy covers before you buy it.
If you are already insured, call your insurance company and ask them to explain exactly what psychiatric treatment is covered by your policy.
This page provides some general information and questions to ask your insurer.
What should I look for when buying private health insurance?
Be careful to ensure that the policy you buy will provide the coverage you want.
Questions to ask your insurer about hospital cover:
- Does this policy cover inpatient psychiatric care in private hospitals? (Often only medium and top-level policies will cover psychiatric treatment.)
- Does it cover all private hospitals or only a selection?
(Insurers have agreements with different hospitals to keep costs down. If your hospital of choice does not have an agreement, you may have to pay more.)
- Is there an annual maximum number of admissions or days in hospital covered?
(Some insurers limit the number of days in a year, or the number of times you can go to hospital.)
- Does it cover re-admission to hospital within days of a previous hospital stay?
(In people with mental health issues, this can be very common – and sometimes insurers won’t pay benefits if this happens.)
- Does it cover day programs in a private hospital? How many days or hours are covered?
- How about outreach or community nursing?
- Are day programs and outreach or community nursing covered at the same time?
(In some cases you can’t claim for both of these services.)
- Is there cover for specific treatments, such as electroconvulsive therapy (ECT)? Are there limits on the number of treatments?
- Is there cover for doctors I might see at the hospital, such as my psychiatrist or anaesthetist?
- What is the excess – the amount I have to pay each time I go to hospital?
Questions to ask if you are considering extras cover:
- What counselling or psychological services are covered?
(There is usually a limit on the number of sessions you can have in a year, or a limit on the amount you can claim.)
Adapted with permission from Uta Mihm, Choice. Read the full article, Good cover essential for mental illness, featuring an interview with RANZCP President Malcolm Hopwood.
What should I do before going to a private hospital?
Before going to hospital as a private patient, you should:
- Call the hospital to discuss your situation. They can explain the costs and alert you to any gap payments for hospital accommodation or doctor’s fees.
- Call your health insurer and ask what will be covered by your health insurance policy.
More about going to hospital
What does private health insurance usually cover for mental health?
Many health insurance policies don’t actually cover psychiatric treatment.
Often only the most expensive (medium and top cover) policies will include it.
In health insurance policies, 'psychiatric treatment' (sometimes called ‘psychiatric services’) usually refers to:
- a stay in a private psychiatric hospital, including accommodation, meals and nursing services, psychologists and allied health professionals you see while in hospital
- 85% of the MBS fee* for doctors and specialists you see while in hospital.
It may also cover:
- outreach or ‘hospital at home’ services
- day programs run out of the hospital
- telephone-based case management by a mental health professional.
*Medicare draws up a list of medical fees, called the Medicare Benefits Schedule (MBS). The fee amounts are decided on by the government, and can be less than what the doctor will charge you.