Will your sessions be paid for by your medical aid?
When prospective clients contact my Cape Town based psychology practice for the first time, we invariable bring up the topic of medical aid payment. For clients on medical aids, the question I get gets asked is – "will my psychotherapy treatment be covered by my medical aid"?
There are a number of aspects to this that you will need to clarify before a definite answer can be given, for example:
1. Is the psychologist, counsellor or coach registered with the Health Professions' Council and with the Board of Healthcare Funders (BHF)?
Only professionally registered psychologists and psychological counsellors can claim from medical aids.
2. Is the registered psychologist, counsellor or coach charging medical aid (BHF) rates?
3. Does the psychologist or counsellor require you to pay upfront for your sessions and then for you to claim back the fee from your medical aid, or are they prepared to submit directly to the medical aid on your behalf?
4. Do you have sufficient funds in your medical aid account to cover number of psychology sessions required?
Each medical aid has its own benefit structure – some have a savings component for all out of hospital medical treatment, with psychology and psychotherapy treatment coming out of this "pot", while other medical aids have a set annual "ceiling" for psychotherapy (this is the annual amount that is "allowed", once this is exceeded the member has to pay for their psychology sessions themselves). Some medical aid plans, on the other hand are a combination of these two – there is a ceiling for claims but then once a certain amount has been spent on medical expenses above that ceiling, medical aid benefits again kick in.
In order to find out this information, you could contact your medical aid and quote the code 86205 which is the BHF code used for an hour of psychotherapy (which is the usual length for an individual psychology session)
5. Is the diagnostic code the psychologist will be using covered by your medical aid?
For some time the BHF have required health care practitioners to provide diagnostic codes for the treatments and procedures that are undertaken. This is also the case for psychologists. The coding system that is currently used is the ICD 10. When you visit your psychologist for the first time, he/she will do an informal or a formal assessment of your concern or problem, and will be required to note a diagnosis on the statement that is sent to your medical aid.
Some medical aids restrict benefits to particular problems or disorders and may sometimes, therefore, refuse to pay for certain types of issues. Sometimes, too, medical aids may restrict benefits to certain categories of psychologists, depending on their scope of practice.
This will be a subject for a future post!