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!

It appears that we can blame it on evolution!

Why is it so difficult to stop our minds drifting to unpleasant and anxiety-provoking topics? Often this happens in the middle of the night, especially to insomniacs who often find that their thoughts prevent them from getting back to sleep.

Well, evolutionary psychologists put it down to the way in which our brains are wired, says Ronald Siegel in his article entitled “West meets East” in the September/October edition of Psychotherapy Networker (in which he discussed the link between psychotherapy and Eastern spiritual practices, such as mindfulness).

The arguement goes that the human beings of today have survived through natural selection only because, through thousands of years, they are the ones who were constantly on the lookout for danger and needed to be extremely adept at anticipating possible risks and life-threatening situations. So anxiety and fear kept you alive whilst happiness and complacency got you killed.

So, although the world has changed a great deal since the days of our cavemen ancestors, our physiology and the wiring of our brains have remained more or less the same, causing us to react to (usually) benign life events, such as traffic snarl-ups and work pressure, asif they were of the magnitude of a tiger hiding in the shadows, waiting to pounce.

So if we are wired for anxiety and stress, what can be done about it?

First it is necessary to develop an awareness of the problem. Then with the help of cognitive-behavioural techniques (CBT), relaxation training and mindfulness techniques it is possible to gain control of one’s thoughts and to calm down the mind. It is important to take on board that one’s thoughts are merely a product of one’s mind and are not necessarily accurate. It is quite possible to substitute more balanced thoughts for thoughts that lead to anxiety, stress and depression. This will help to calm the mind, paving the way for a more measured, focused and appreciative approach to life, including one’s relationships.

And this can only lead to an inhanced feeling of happiness and contentment!

Research has consistently indicated that people, on average, feel happier and more emotionally stable as they move into middle and old age. This seems surprising as this period of one’s life is when we become acutely aware that our bodies and minds are not as efficient as they were in our youth, and when we experience health-related problems and physical and psychological losses and crises.

However, it appears that in the midst of all our ageing-related challenges and problems we are nontheless more happy and emotionally stable according to an article in the journal Psychology and Aging (October 2010), as cited in New Therapist Magazine (January/February 2011)

Why is this?

Perhaps because:

As we get older we become more aware of our mortality and that time is running out. We therefore live in a more mindful and balanced way, enjoying the joys and pleasures of the everyday life, taking nothing for granted.

We become more and more aware that our time on this earth is limited and this leads to our becoming a lot more selective in what we choose to do with our time.

In my view, the take-home message from this research is : we could all live happier lives, irrespective of our age, if we make a point of living every day in a mindful, balanced way!

And that Positive Psychology and Mindfulness training should be considered integral to psychotherapy!

As a psychologist based in the southern suburbs of Cape Town for the last seventeen years, the predominant problem that has brought, and continues to bring  both individuals and couples into therapy involves relationships. Even when clients contact me because they are suffering from depression and/or anxiety, the cause in seven out of ten cases relates to problems in their intimate relationships.

Our attachment bonds are so crucial to our sense of security and our emotional well-being, thus when they are threatened or severed, the individuals involved are often plunged into an crisis and often experience an emotional melt-down.

In order to keep our important relationships healthy and vital, we pay attention to them in the same way as a gardener tends a vegetable garden. Respect and goodwill need to be cultivated in order to strengthen and maintain the relationship bonds with the significant people in our lives.

Have a happy, loving and relaxing festive season!