Telehealth Mental Health Costs Under Scrutiny Amid Regulatory Gaps

A Victorian woman's experience with a national telehealth psychiatry service has exposed significant concerns about pricing transparency and regulatory oversight in Australia's rapidly expanding digital mental health sector.

The case highlights broader systemic issues affecting vulnerable patients seeking mental health care, particularly ADHD diagnosis and treatment, amid a national shortage of psychiatrists and lengthy waiting lists.

Disputed Charges and Service Quality

Tamara, a 42-year-old regional Victorian, sought an ADHD diagnosis through HelloDoc, a national telehealth service, after struggling to find an available local psychiatrist. Her experience raises questions about billing practices and service quality in the telehealth sector.

Initially charged $750 for a diagnostic consultation, Tamara received a Medicare rebate leaving her $495 out of pocket. A second diagnostic appointment cost $910, with Tamara claiming the ADHD diagnosis was delivered in approximately 20 minutes despite being billed for a 45-minute consultation.

"I was diagnosed in a very short period of time, for a much longer appointment claimed," Tamara told reporters. "Having been rediagnosed with a local psychiatrist who asked detailed personal questions, there is a huge difference in assessment quality."

A subsequent follow-up appointment was charged at $670, allegedly lasting only 10 minutes while being billed as a 30-minute video consultation. After Medicare rebates, Tamara remained $539 out of pocket.

Transfer of Care Complications

When Tamara's GP advised requesting a transfer of care to a local provider, HelloDoc allegedly demanded an additional $500 appointment fee to facilitate the transfer, describing clinical discussions as "non-negotiable requirements" aligned with medicolegal obligations.

"They didn't give me any option," Tamara said. "It's not fair to charge somebody $500 for something they've requested in a previous appointment and been unreasonably denied."

HelloDoc subsequently cited a "zero-tolerance policy for abusive or aggressive behaviour" in response to Tamara's complaints, though she denies any inappropriate conduct.

Regulatory Complexity

The case exposes significant gaps in regulatory oversight for interstate telehealth services. Tamara filed complaints with multiple bodies across three states, experiencing jurisdictional confusion.

"HelloDoc's clinic is registered in South Australia, I live in Victoria, and the service was provided in Queensland. Where do you complain for price gouging?" she asked. "Victorian Health Care Complaints rejected it and referred to South Australia. South Australia rejected it and referred to Queensland."

This regulatory maze reflects broader challenges in governing digital health services that operate across state boundaries, potentially leaving patients with limited recourse for disputes.

Professional Standards and Assessment Requirements

Australian Society of Psychiatrists chief executive Dr Pramudie Gunaratne emphasised the complexity of ADHD diagnosis, noting that proper assessment requires substantial time regardless of delivery method.

"ADHD is a neurodevelopmental condition with higher rates of comorbidities like autism spectrum disorder and OCD. A good assessment screens for these conditions," Dr Gunaratne explained. "Inattention can be caused by depression, anxiety, or trauma, so thorough screening is essential."

From clinical practice, Dr Gunaratne indicated psychiatrists typically require one to two hours for proper ADHD assessment, with close monitoring needed when initiating medication due to potential cardiac and psychological risks.

Industry Growth and Transparency Concerns

Telehealth psychiatry services have experienced dramatic growth, with Medicare records showing almost 79,000 services provided in 2024-25, up nearly 5,000 from the previous year. This financial year has already seen 21,884 telehealth psychiatry services delivered.

"If people were aware of significant follow-up appointment costs and medication management fees, they wouldn't pursue these services initially," Tamara observed. "Their website discloses absolutely nothing about pricing."

Her new local psychiatry service charges $200 for medication management, highlighting significant price variations across providers.

Policy Reform Considerations

Some states, including New South Wales, have expanded GP authority to diagnose and medicate ADHD, though Victoria has not implemented similar measures. Tamara advocates for nationwide implementation of such reforms to improve accessibility.

Dr Gunaratne supports expanded GP involvement but emphasises the need for robust training, oversight, and escalation pathways to ensure patient safety.

"If cases are complex or problems arise, there must be pathways for GPs to collaborate with specialists," she noted.

Service Provider Response

HelloDoc declined to comment on individual cases, citing patient confidentiality obligations. A spokesperson rejected characterisations of the claims as "selective, lacking critical context, and not reflecting the reality of our services or commitment to safe, accessible care."

The service described itself as "a long-established telepsychiatry service delivering mental health care across Australia for many years, supporting thousands of patients annually through experienced psychiatrists."

This case underscores the urgent need for clearer regulatory frameworks governing interstate telehealth services, pricing transparency requirements, and streamlined complaint mechanisms to protect vulnerable patients seeking mental health care in Australia's evolving digital health landscape.