The good news is that if you have private health insurance, this burden may be significantly reduced when seeking treatment in an accredited clinic or hospital such as those managed by Avive Health.
General practitioner Dr Nic Giummarra, a GP Specialist at Avive Clinic Mornington Peninsula with a background in mental health and addictions, says understanding what’s covered – and the options available to shorten waiting times – helps people make more informed choices.
Dr Nic explains that most private health funds only cover treatment provided in a facility that holds a medical licence – not those operating under a business licence.
“Most people don’t realise that private health insurance only pays for care delivered in an accredited hospital or clinic that meets strict safety and quality standards set by the Australian Government,” he says.
“That means non-accredited private rehabilitation centres, such as retreat-style or lifestyle-focused programs, are generally not covered by private health funds. These facilities usually operate under a business licence rather than a medical licence, so their fees need to be paid entirely by the patient.”
At Avive Health, our hospitals and clinics are accredited under the National Safety and Quality Health Service (NSQHS) Standards. Depending on individual health-fund policies and eligibility, this may allow patients with private hospital cover to access detoxification and rehabilitation services with limited out-of-pocket costs after the standard admission excess.
Many people delay care because of waiting periods. Some health funds offer a once-in-a-lifetime psychiatric waiting period waiver that can help eligible members access hospital-based mental health and addiction treatment sooner.
Our dedicated intake team can provide general information about admission pathways and the documentation your health fund may request while you confirm eligibility and benefits directly with your insurer.
If you don’t have private health insurance, you can still access care through Avive’s self-funded admission pathway. Costs vary based on individual needs, but are typically around A$1,700 – A$2,000 per day, which includes:
“Our team always provides a clear quote upfront. Transparency is an important part of good medical care,” says Dr Nic.
If you decide to take out private health insurance, most funds have a two-month waiting period before you can claim for addiction or mental health care. People may qualify for the once-in-a-lifetime psychiatric waiting period waiver when upgrading their existing hospital cover, which may allow earlier access to eligible services under the upgraded policy.
“If someone chooses to delay their admission to meet insurance waiting periods, we don’t leave them unsupported,” says Dr Nic.
“We arrange an assessment with one of our intake nurses, plan their pathway, and can provide rebated telehealth psychiatrist appointments in the interim. This ensures that even during the waiting period, people can start preparing for a safe recovery.”
If a mental health and addiction treatment facility can’t clearly explain its fees, accreditation or insurance eligibility – that’s a red flag.
“At Avive, we believe people deserve honesty. Addiction recovery is already a vulnerable time. People should be able to make informed choices about their care and understand the financial aspects clearly,” says Dr Nic.
If you’re exploring treatment options or want to understand how the mental health waiting period waiver might apply to your situation, our team can help guide you through the next steps.
Contact Avive Health to speak with our intake team or request a confidential discussion about admission pathways and accessing the help you need.
P: 1800 284 830
Disclaimer:
This article provides general information only and is not a substitute for medical or financial advice. Eligibility, coverage, waiting periods and fees vary by health fund and personal circumstances. Please speak with your GP, psychiatrist or health fund before making decisions about treatment or insurance.