The insurer partially approved a treatment plan for psychological treatment because the recommendation was made by a psychotherapist, who was an unregulated provider under the Professional Services Guideline, and therefore was subject to the hourly rate of $99.75 as opposed to the $149.61 per hour rate claimed. Adjudicator Boyce found that the claimant was not entitled to the remainder of the treatment plan as the proposed rate was outside of the hourly fee provided by the Guideline. The Guideline provides that, for non-catastrophic impairments, the maximum hourly rate for psychologists and psychological associates is higher than that for psychometrists and counsellors (being family, rehabilitation, vocational). For services provided by health care professionals, unregulated providers and other occupations not listed in the Guideline, the amounts payable by an insurer related to services not covered by the Guideline are to be determined by the parties involved. Adjudicator Boyce agreed with the insurer that the individual’s CV in question confirmed that his practice was as a psychotherapist or psychometrist, which is not listed in the Guideline. Further, there was no evidence that the individual possessed specialized training. As a result, Adjudicator Boyce determined that the claimant had not provided support for the contention that they were entitled to the balance of the treatment plan.
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