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Question
Posted by: Maria | 2012-01-19

Discovery''s disappearing mental health benefit

Hey CS

I hope some other reader can help me out here. I''m on Discovery Classic Comprehensive. They did away with the mental health benefit this year, and lumped together psychologist visits with other professionals like physio, chiro, OT and audiologist, with a very low limit of R13500 for my daughter and myself. There is no way that is going to be nearly enough for us, judging by our claims of last year. I said to my husband, I''m going to have to choose between being crazy and needing psychotherapy, spraining an ankle or falling off my horse like I did in October and needing physio and chiro, because I can''t afford both! Of course falling off horses aren''t compulsory and I don''t do it often but you can''t predict it either.

I hear on the radio that 100''s of Discovery clients are protesting against the changes, how can I get involved with that? Other than on FaceBook, I don''t do FB.

Are there loopholes? Does anybody know how they will pay if you have psychotherapy from a psychiatrist rather than a psychologist? Psychiatrist visits are unlimited if I understand correctly. I''m trying to get this info out of Discovery but dealing with them is painful like puling teeth without anesthetic.

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Our expert says:
Expert ImageCyberShrink

I wish the Dept of Health would kep a close eye on Medical Aid schemes that refuse to cover major health needs, and remind them that the constitution does not allow discrimination on the basis of having one type of illness rather than another.
OT and Chiropraxy have veruy little good scientific evidence of value, and should not be pumped with scientifically validated psychiatric and psychological therapies - its ignorant of medical Aids to do so. Similarly, it's nonsense for them to treat Major Depressiopn and Bipolar Disorder differently.
Payment for psychotherapy should depend on it being psychotherapy, and not on whether it is delivered by a psychiatrist or a psychologist.

The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.

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Our users say:
Posted by: Maria | 2012-01-19

CS and I will have to agree to disagree on the value of OT and chiropractic since I''ve personally experience positive value from both!

Reply to Maria
Posted by: Liza | 2012-01-19

That is how I understand it too. The psychologist must just use exactly the same code for claims as specified in the motivation - otherwise they''re full of nonsense.

Reply to Liza
Posted by: Maria | 2012-01-19

Hi Liza, thanks. Sorry I should have mentioned my current diagnoses is Major Depression although I want to challenge that, so that gives me less benefits on PMB than someone with Bipolar. So you can get 15 psychotherapy sessions and anything more comes out of the Allied Health Professionals benefit if I understand it correctly.

Reply to Maria
Posted by: Liza | 2012-01-19

I''m also on Discovery Classic Comprehensive. Not quite sure whether you''re bipolar or just have depression? In any case, Depression is on the list of extended chronic conditions that they pay out of PMB - you just need your psychologist to submit a motivation for your sessions to be paid out of PMB. That way it doesn''t even come out of your savings. My psychiatrist gives me CBT, but he claims with the same code as what a psychologist would use - so it counts as a psychologist visit. He sends the motivation for a certain amount of visits to the medical aid and they''ve already paid the first claim for this year from him - out of PMB benefits.

Hope this helps
Liza

Reply to Liza
Posted by: Maria | 2012-01-19

In addition... are the PMB still in effect like they were last year? Is Discovery obliged to pay for either 21 days of hospitalisation or 15 psych sessions out of PMB?

Reply to Maria
Posted by: cybershrink | 2012-01-19

I wish the Dept of Health would kep a close eye on Medical Aid schemes that refuse to cover major health needs, and remind them that the constitution does not allow discrimination on the basis of having one type of illness rather than another.
OT and Chiropraxy have veruy little good scientific evidence of value, and should not be pumped with scientifically validated psychiatric and psychological therapies - its ignorant of medical Aids to do so. Similarly, it's nonsense for them to treat Major Depressiopn and Bipolar Disorder differently.
Payment for psychotherapy should depend on it being psychotherapy, and not on whether it is delivered by a psychiatrist or a psychologist.

Reply to cybershrink

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