Medical schemes to pay psychologists full rates for virtual consultation rates

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South Africa’s biggest medical scheme administrators, Discovery Health and Medscheme, have softened their stance on virtual consultations with psychologists and agreed to pay out at the same rate as they would previously have done for face-to-face sessions.

Business Day reports that this was after the SA Medical Association, last week, expressed concern that Discovery Health and Medscheme were offering lower rates for virtual consultations covered by their client schemes.

At the time, both administrators said their policies were in line with international best practice and reflected the fact that virtual consultations did not involve a physical examination and had lower input costs.

The report says direct consultations with medical practitioners have plummeted across the board, as patients and health-care professionals seek to minimise their potential exposure to the Sars-CoV-2 virus, which causes COVID-19.

“We recognise that the primary reasons for the lower consult rate for most health-care practitioners do not apply to psychologists. Consequently, it is fair, after constructive engagement with the psychologists, to adjust the tariff accordingly,” said Discovery Health CEO Ryan Noach.

Medscheme’s executive director for health-care management, Lungi Nyathi, said the administrator had agreed with the Clinical Psychology Forum (CPF) that virtual psychotherapy would be reimbursed at the same rate as face-to-face sessions.

A psychologist says she stumbled on a form on Discovery’s website about a week ago stating that they’d only be paid 65% of their face-to-face therapy rate, reports Business Day. Dr Linda Blokland, who heads the Clinical Psychology Forum, says that when her organisation contacted Discovery, the medical scheme “um-ed and ah-ed, and dragged their feet” on explaining why these payments were lower.

“None of us had been informed. Medical aid members didn’t know anything about it. A 35% cut (in pay) is massive.”

Discovery’s initial argument was that telemedicine costs less, since professionals don’t use rooms, gloves or consumables, or need a secretary to set up appointments. In many cases, it said, appointments are also shorter. Blokland’s group rejected this reasoning. “We have not fired our admin staff,” she says. And besides that, the therapists must still pay for medical insurance, rent rooms and have secretaries.

Full Business Day report

Full Business Day report

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