'Posh kids' therapy to blame'
Speech and occupational therapists linked to top private schools in the northern suburbs of Johannesburg and the Cape Winelands are said to be partly to blame for Discovery Health's changes to its health cover - described by many members as less value for more money.
The scheme introduced the changes this month.
In an attempt to calm a recent outcry about them, Discovery CEO Jonathan Broomberg yesterday said that fraud had forced his company's hand.
The previously unlimited coverage for visits to allied health professionals (speech and occupational therapists, art therapists, podiatrists, chiropractors, physiotherapists, audiologists and biokineticists) had been abused by "some providers" and "some members", he said.
An example was the member who in one year claimed for 490 visits to a physiotherapist.
Some members living in Johannesburg's northern suburbs claimed for an average of 17 visits to a speech therapist per year - almost three times the national average. One member claimed for 211 appointments with a speech therapist.
Broomberg said he hoped the changes would curb increasing fraud on Discovery's top benefit packages, the executive and comprehensive plans.
The scheme's health actuary, Alain Peddle, said some allied health professionals, such as biokineticists, speech therapists and occupational therapists, operated within schools, giving them greater access to potential patients.
The professionals sometimes used a room at a school, or set up near the school, and offered to evaluate pupils in a class once a week.
Broomberg said he knew of an entire class, "20 out of 20 pupils", who were receiving one-on-one attention from an occupational therapist to "correct muscle grip" and help them better hold a pencil.
One family racked up claims to the value of R200000 for visits to allied health professionals.
The eldest child went to an occupational therapist 156 times for hand grip and coordination skills.
The second child went to a physiotherapist 50 times for a suspected ankle strain and the mother visited a physiotherapist 150 times for musculo-skeletal pain.
In another bizarre claim, a physiotherapist claimed R46000 for two weekly visits by one of his patients who was said to be suffering from tension headaches.
Board of Healthcare Funders spokesman Heidi Kruger said: "No health system in the world can cover everybody for every single thing."
A group of Discovery members has started an online petition (Pressure Discovery Medical Aid to change limits on Allied Medical) and a Facebook group in protest.