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Bupa FAQs

Frequently Asked Questions

What benefits does Bupa offer?
Bupa offers benefits for counselling and psychotherapy services provided by practitioners who meet Bupa’s recognition criteria, and hold a current Provider Number. Benefits for these services fall under the category called “Mental Health” in several Bupa Extras Products.

Which providers have benefits payable for counselling services?
Benefits are payable for practitioners in private practice who meet Bupa’s provider recognition criteria for counselling services. In relation to provider recognition by Bupa for the purposes of paying benefits for counselling services, the use of the term “counselling” is understood to include “psychotherapy”.

How do I know if I meet Bupa’s recognition criteria for counselling services?
Please see here for the eligibility criteria.

Do Bupa have a grandfathering pathway to becoming a recognised provider?
Yes. If you have completed a counselling or psychotherapy training program of a minimum of 3 years in length, over 15 years ago, and have been in practice for a minimum of 10 years, you may be eligible for the Bupa grandfathering program. Please contact [email protected] for further information.

Will I be issued with a provider number?
Bupa will issue a provider number for your practice location. If you practise in more than one location, a separate provider number will be issued for each location. You can register up to 4 provider locations with Bupa, unless we otherwise agree in writing. You should notify PACFA at [email protected] immediately if there are any changes to your practice address/es.

Does my provider number have to appear on my invoices and receipts?
Yes, your Bupa provider number/s should be either printed or stamped on your official invoices and receipts. Additionally, your name, practice address, date of service, client name, item number, and item description (see below) should appear on the invoice.

What services are claimable through Bupa for counselling services?
Bupa pays benefits on an attendance basis. For counselling services provided by a Bupa recognised practitioner, a benefit is payable for one attendance, per member, per day, in accordance with the Bupa member’s product entitlement, yearly limits and Bupa’s fund rules. Services claimable are as follows, and invoices/receipts should be issued with the appropriate service description (as below) for the service provided to the Bupa member.

Service Description:

  • Initial attendance – please note – a maximum of one initial attendance is payable per member, per provider, in a 12 month period
  • Subsequent attendance
  • A couple or family attendance
  • Group attendance

Does Bupa offer telehealth?
Yes. As part of Bupa's response to COVID19, temporary provisions for telehealth were introduced. Bupa has since confirmed that telehealth will remain as a permanent provision for eligible customers. Please see here for their media release, and below for the item numbers required.

I only want to use my number for telehealth do I have to apply for an online only provider number?

No. Even for telehealth the provider numbers require a physical address- this means you cannot apply for a number for 'online only' you can only invoice with a physical address attached to the provider number we recommend continuing to use your practice address associated with a provider number for the invoices but use the code (as listed below) for the telehealth item number. 

Do I have to include an item number on the invoice/receipt as well as the service descriptions?
It is not mandatory to include the item number on the invoice if the description of the service is clearly stated. Different private health insurance funds will use different item numbers. If you chose to include the item number as well as service description, the relevant Bupa item numbers are listed below for your reference.

 Item Number   Service Description   Notes 
 J100  Initial attendance  A maximum of one initial attendance is payable per member (per provider), in a 12 month period   
 J200  Subsequent attendance  
 J300  A couple or family attendance   
 J400  Group attendance  
 701  Individual Initial referred assessment by teleconsultation   A maximum of one initial attendance is payable per member (per provider), in a 12 month period
 801   Individual subsequent treatment by teleconsultation  
 802  Couple or family attendance by teleconsultation  

Why is there a rule around initial attendances and when can I bill an initial attendance?
Bupa has certain business rules that govern the way claims are paid. Bupa would expect to be billed for an initial attendance in the following circumstances:

  • when a new client commences treatment
  • when an existing client starts a new course of treatment for a different condition to that previously addressed with counselling
  • when an existing client has had a break in counselling for an extended period of time (over 2 years) and then recommences treatment

Are the same service descriptions and item numbers used regardless of whether psychotherapy or counselling services are being provided?
Yes. As a Bupa recognised provider, we understand that a range of different modalities may be used when working with a client. For the purposes of paying a benefit, Bupa will refer to all services provided by recognised providers under the banner of “counselling services” as “counselling”. Irrespective of whether the practitioner may consider the service provided to be “psychotherapy” or “counselling”, the appropriate service description from the list above should be used to describe the service provided at each attendance. 

Can I claim for the writing and provision of a report or assessment requested for medical or legal purposes?
No. Bupa will pay benefits only for the actual provision of counselling services directly to a Bupa member. No benefits apply to the preparation and provision of reports and assessments.

Will payment for these counselling services be available through point of service claiming technologies such as HICAPS or CSC HealthPoint?
No. Bupa members will need to submit their claims to Bupa by mail, at a Bupa Retail Store or online via MyBupa.

Will all Bupa products pay benefits for counselling?
Benefits for counselling services will only be paid for members on the appropriate level of extras cover. Extras covers include benefits for services that are not inpatient/hospital services, many of which are delivered by allied health providers.

What should I tell a Bupa member who queries how much they’ll get back from Bupa for a service?
There are a number of factors that can affect what benefit is payable, including the product the member is on, waiting periods, and yearly limits. We recommend that the client should contact Bupa directly on 134 135 to determine their benefit entitlements.

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