Discovery Health causes uproar
The Discovery Health medical aid scheme has caused an uproar by limiting how much it will pay for the services of 15 categories of health professional.
The country's biggest open medical scheme said it had been forced to act to combat fraud.
Health services for which payments will be limited include those of psychologists, biokineticists, physiotherapists and dieticians.
Discovery Health CEO Jonathan Broomberg said abuses included members claiming for frequent sessions with biokineticists, whose services were previously given unlimited coverage on some options, who acted as personal trainers.
He said there had been abuse of disciplines such as occupational therapy and educational psychology. Members used the scheme's benefits for services that should be provided by, for example, schools.
In order to limit the abuse, the medical aid scheme has created a benefit category that offered limited annual cover for visits to, among others, art therapists, chiropractors, hearing-aid acousticians, homeopaths, podiatrists, psychometrists, registered nurses, social workers and speech therapists.
But Discovery's move has left the SA Depression and Anxiety Group fuming because it "lumps clinical psychology with homeopathy", undermining the status of psychology in the treatment of the popularly stigmatised mental illnesses that require regular treatment by psychologists.
Once the annual limit is exhausted, members will have to pay for their treatment themselves.
The group's spokesman, Cassey Chambers, said that patients with bipolar disorder were prescribed chronic medication and advised to see a psychologist.
"Often, treatment is for life and the condition needs constant and intense management," she said.
She said that Discovery's benefit limits amounted to "taking a step backwards and severely cutting access to mental-health treatment".
The Medical Research Council estimates that 15.8% of South Africans suffer from an anxiety disorder.
Psychiatrist Dora Wynchank said: "It is a major insult to many psychologists and discriminatory to the profession as a whole."
But Broomberg defended the move, saying that members with serious clinical conditions would have an "extender benefit" that gave them unlimited access to specific healthcare professionals.
Butsi Tladi, head of the inland region of Alexander Forbes Health, said: "Discovery would not have made the changes if it did not have significant impact on its financials and how members claim."
Clayton Samsodien, managing director of Genesis Healthcare Consultants, said: "I really feel for the members . medical schemes are paying less, providers are charging more and the poor members must just cough up."
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