Why medical aid schemes don't pay for chronic depression and anxiety meds

It is estimated that a third of South Africans suffer from some form of mental illness.

One of the major issues is that most medical aid schemes do not cover medication for depression and anxiety. This means that those who need to take medication for depression and anxiety need to fork out thousands of rand a year in order to function.

Dr Oluritini Modupe, senior manager at the Council of Medical Schemes, says depression is covered under Developmental Trauma Disorder (DTD) per code 91OT which is titled acute delusional mood anxiety personality and perception disorder and organic mental disorders.

Read: Traffic chief's stop to assist fellow motorist turns into traumatic experience

The care of that is provided for in the Act, the Prescribed Minimum Benefits Regulations to the Medical Schemes Act as hospital-based treatment for up to three days.

Dr Oluritini Modupe, Senior manager at the Council of Medical Schemes

Modupe says after three days, the patient will be assessed and if it is diagnosed that the patient still needs care it will then be referred to scheme rules. The scheme rules vary from one medical aid to another depending on the patient's plan options.

According to the Act, the medical aid should be able to pay for the minimum benefits but once the prescribed minimum benefits are exhausted, the scheme's rules that apply to the member's particular option kicks in.

Obviously, we need to try and rectify and we have been doing that since 2016 in a form of PMB review exercise just to come with a revision of the current package, cost it and ensure that it is affordable.

Dr Oluritini Modupe, Senior manager at the Council of Medical Schemes

To hear the rest of the conversation with Dr Oluritini Modupe, listen below:


This article first appeared on CapeTalk : Why medical aid schemes don't pay for chronic depression and anxiety meds


Recommended

by NEWSROOM AI
Read More
Questions over data and paid influencers used in tobacco-funded ad campaign

Questions over data and paid influencers used in tobacco-funded ad campaign

In the campaign, Tisa argues that the government should prioritise the R7-billion lost in tax revenue due to illicit cigarettes.

Why the vitamin IV drip isn't a great idea for 'boosting energy'

Why the vitamin IV drip isn't a great idea for 'boosting energy'

A dietitian warns that the IV drips pose risks for bacterial infections, toxication, kidney stones and other medical consequences.

[LISTEN] Decolonising medical ethics

[LISTEN] Decolonising medical ethics

Eusebius discusses with health ombud Prof. Malegapuru Makgoba the history of medicine during colonial times and after 1994.

What you need to know...when you find a foreign object in your food

What you need to know...when you find a foreign object in your food

ConsumerTalk's Wendy Knowler gives you some tips on what to do when this happens.

[LISTEN] NHI implementation will take massive reorganisation -  Aaron Motsoaledi

[LISTEN] NHI implementation will take massive reorganisation - Aaron Motsoaledi

Health Minister Aaron Motsoaledi announced last week, amendments to two bills including the the National Health Insurance (NHI).

Court deciding whether to allow new medical evidence in Van Breda murder case

Court deciding whether to allow new medical evidence in Van Breda murder case

Western Cape High Court heard a request for a defence psychologist to take the stand for axe murder accused Henri van Breda.

Popular articles
Capitec Bank has the strongest brand of any company in South Africa

Capitec Bank has the strongest brand of any company in South Africa

Castle Lager came in second, followed by FNB, Black Label, Discovery and Vodacom, according to the 2019 Brand Finance report.

I haven’t saved. I intend to work well into my 100s - Leon Louw (FMF)

I haven’t saved. I intend to work well into my 100s - Leon Louw (FMF)

Bruce Whitfield talks to Leon Louw (Free Market Foundation) about his attitude toward money (hopes, fears, successes, failures...)

3 best JSE and offshore shares to buy, right now (by Anchor Capital)

3 best JSE and offshore shares to buy, right now (by Anchor Capital)

The Money Show’s Bruce Whitfield asks Henry Biddlecombe (an analyst at Anchor Capital) for his stock picks of the week.

Advisor scams pensioners out of R100 million with promises of 14% returns

Advisor scams pensioners out of R100 million with promises of 14% returns

Bruce Whitfield interviews Phillip de Wet (Business Insider), Robert Walton (Boutique Collective Investments) and Brandon Topham.

'We find connections between gangs in Cape Town, Johannesburg and Durban'

'We find connections between gangs in Cape Town, Johannesburg and Durban'

Global Initiative against Transnational Organised Crime's Simone Haysom says gangs operate far broader than the Western Cape.

'I should have told the Sunday Times the pot smoking was irrelevant'

'I should have told the Sunday Times the pot smoking was irrelevant'

Investigative journalist Jacques Pauw says he's sorry for any harm caused in his article on Mkhwebane and her principal witness.

I decided to make this Rihanna song with my maskandi vision - Mbuzeni Mkhize

I decided to make this Rihanna song with my maskandi vision - Mbuzeni Mkhize

After South African star Mbuzeni Mkhize performed a remix of Rihanna's track 'Diamonds' she contacted him to collaborate with her.

What are the best investment options if you decide to go it alone?

What are the best investment options if you decide to go it alone?

Certified financial planner Paul Roelofse gives the lowdown on the money market, retail bonds and exchange-traded funds.