If you are concerned that you or someone you care about is experiencing an eating disorder, such as anorexia nervosa, bulimia nervosa or binge eating disorder, it’s important to make an appointment with a medical practitioner. For most people this will be a GP, but it also includes paediatricians and psychiatrists.

• It’s important to see your regular GP who knows you, or a GP that you are comfortable with. If you don’t have a regular GP, look for a GP that has ‘mental health’ as one of their treating specialties.
• To ensure there is adequate time to cover the assessment and referral process, it is advisable that you ask for a double appointment when you book and mention that you are wanting an Eating Disorder Plan (EDP).

When you’ve made an appointment, it’s a good idea to start getting prepared for your appointment so you don’t feel put on the spot. It might be helpful to write down any symptoms or behaviours you’ve been experiencing, as well as any questions you might want to ask the doctor.

Going to the doctor for concerns around an eating disorder can feel like a big step. Understanding what is likely to happen at your appointment can help ease your anxiety.

Read more about talking to your GP

Eating disorders can affect anyone, and the signs and symptoms are different for everyone. It’s important to get diagnosed by a professional so that you can access appropriate treatment.

Do I have an eating disorder?

The doctor will assess your eating disorder symptoms using a range of measures to assess whether you are eligible for an Eating Disorder Plan (EDP) under Medicare. This will include:

• Eating Disorder Examination Questionnaire (EDE-Q) (you may want to pre-fill this out before your appointment);
• a mental state examination;
• taking of relevant history (biological, psychological, behavioural, nutritional, social);
• assessing associated risk and any co-morbidity; and
• making a psychiatric diagnosis for conditions meeting the eligibility criteria
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If you are given an Eating Disorder Plan (EDP), you will be required to see a psychiatrist or a paediatrician after 20 Eating Disorder Psychological Treatment (EDPT) sessions. Due to the availability of these specialists, it is important that your GP make this referral in your initial appointment or at your 10 session review.

Your appointment with a psychiatrist or paediatrician can happen any time before the 20 session review.

According to the Medicare Benefits Scheduling Book (pg 182-195), the eligibility criteria for an Eating Disorder Plan is:

a. Patients with a clinical diagnosis of anorexia nervosa; or
b. Patients who meet the eligibility criteria (below), and have a clinical diagnosis of any of the following conditions:

a. bulimia nervosa;
b. binge-eating disorder;
c. other specified feeding or eating disorder.

The eligibility criteria, for a patient, is:

a. a person who has been assessed as having an Eating Disorder Examination Questionnaire score of 3 or more; and
b. the condition is characterised by rapid weight loss, or frequent binge eating or inappropriate compensatory behaviour as manifested by 3 or more occurrences per week; and
c. a person who has at least two of the following indicators:

a. clinically underweight with a body weight less than 85% of expected weight where weight loss is directly attributable to the eating disorder;
b. current or high risk of medical complications due to eating disorder behaviours and symptoms;
c. serious comorbid medical or psychological conditions significantly impacting on medical or psychological health status with impacts on function;
d. the person has been admitted to a hospital for an eating disorder in the previous 12 months;
e. inadequate treatment response to evidence based eating disorder treatment over the past six months despite active and consistent participation.

If you are eligible for an Eating Disorder Plan (EDP) you will begin the initial course of treatment. 

This includes:

• 20 sessions with a dietitian
• 10 Eating Disorder Psychological Treatment (EDPT) sessions

Mental health clinicians who can administer the EDPT sessions include psychologists, mental health social workers, mental health occupational therapists.

It is advised you see a mental health clinician who is experienced in treating eating disorders. 

Mental health practitioners must use specific psychological treatments to claim the Medicare rebate for their services. The approved psychological treatments are:

• Family Based Treatment for Eating Disorders (EDs) (including whole family, Parent Based Therapy, parent only or separated therapy)
• Adolescent Focused Therapy for EDs
• Cognitive Behavioural Therapy (CBT) for EDs (CBT-ED)
• CBT-Anorexia Nervosa (AN) (CBT-AN)
• CBT for Bulimia Nervosa (BN) and Binge-eating Disorder (BED) (CBT-BN and CBT-BED)
• Specialist Supportive Clinical Management (SSCM) for EDs
• Maudsley Model of Anorexia Treatment in Adults (MANTRA)
• Interpersonal Therapy (IPT) for BN, BED
• Dialectical Behavioural Therapy (DBT) for BN, BED
• Focal psychodynamic therapy for EDs

After 10 EDPT sessions, you will need to see your GP or other managing practitioner to review your EDP. Your doctor will review your progress against the EDP and recommend whether you should continue with the Medicare plan.

If recommended, you will be referred for another 10 EDPT sessions.

After 20 EDPT sessions you will need to see both your GP and a psychiatrist or paediatrician. It is recommended that this specialist referral is made at your initial appointment or at the latest at your 10 session review.

Should both practitioners recommend more intensive treatment, you will be referred for another 10 EDPT sessions.

Note: The psychiatrist/paediatrician appointment does not need to take place after the completion of 20 EDPT sessions. It can happen any time before the 20 session review. 

After 30 EDPT sessions you will need to see your GP or other managing practitioner to review the EDP.

If recommended, you will be referred for a final 10 EDPT sessions under the Medicare plan for that year.

If you still have sessions left on a Mental Health Care Plan (MHCP) under Medicare, you will be required to use the remaining sessions before commencing an Eating Disorder Plan (EDP). You may still want to visit your GP in the lead up to the completion of your Mental Health Care Plan to prepare for potentially moving onto an EDP.

The sessions used on the Mental Health Care plan will come off your total entitlement to EDPT sessions on the Eating Disorder Plan (EDP). For example, if you have used 10 MHCP sessions, you would only get a maximum of 30 EDP sessions in that 12-month period.

Rebateable service fees will remain the same as the existing Mental Health MBS item numbers.

For most services, you will be required to make a ‘gap’ payment. Gap payments are dependent on the fees set by your treating clinicians.

For more information about item numbers and fees, please see see the Eating Disorders MBS item numbers Quick Reference Guide from the Department of Health.

An Eating Disorder Plan (EDP) under Medicare will not be a suitable treatment approach for everyone. If your doctor does not recommend an EDP, there are a number of options that may be more suitable for you.

• Your GP may decide you that will be better treated in the public health system. You will be referred to the appropriate services, such as a hospital, in your local area. EDV can help connect you with these services.
• Your GP may refer you to the existing Better Access model, which entitles you to 10 subsidized sessions with a mental health clinician. EDV can help you find a psychologist who specialises in eating disorders.
• Your GP may recommend another course of action that does not fit into any of the above models.

Unfortunately, not everyone has a good experience when seeking help for an eating disorder. If your doctor does not diagnose an eating disorder or does not recommend an EDP but you are still concerned about warning signs and symptoms, it’s a good idea to get a second opinion.