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Will my medical aid pay?

Is PSYCHOLOGY Covered By Your MEDICAL AID?

And if I don't have a MEDICAL AID, what are the costs?

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Psychology does not come cheap,

but, neither does medical aid, and therefor you should be able to access basic mental healthcare, if you are on a medical aid.

Most medical aid plans, regardless of the provider has something called 'Prescribed Minimum Benefits', (PMB), which you may not be aware of, and thus, not utilize it for much needed mental health services. (We'll explain below)

PMB explianed

WHAT IS PMB?

The following has been derived from the 'discovey.co.za' website.

According to the Medical Schemes Act 131 of 1998 and its Regulations, all medical schemes have to cover the costs related to the diagnosis, treatment and care of:

  1. Any life-threatening emergency medical condition

  2. A defined set of 270 diagnoses

  3. 27 chronic conditions (Chronic Disease List conditions)

In most cases your PMB will cover, EITHER in-hospital mental health treatment or out-of-hospital mental health treatment, which is what we offer as psychologists.

REQUIREMENTS

The following has been derived from the 'discovey.co.za' website.

There are certain requirements before you can benefit from Prescribed Minimum Benefits. The requirements are:

  1. The condition must qualify for cover and be on the list of defined PMB conditions.

  2. The treatment needed must match the treatments in the defined benefits on the PMB list.

  3. You must use the Scheme's DSPs for full cover unless there is no DSP applicable to your plan.

WHO APPLIES?

Psych Central will apply to your medical aid provider, IF the treating psychologist are satisfied that you meet the requirements.

The assessment will be done during your first intake-session, which means that you'll need to pay for your first session, either in cash, or we can claim from your medical aid savings, if available.

This application usually takes about a week to get processed, but can take longer.

PAYMENT

Once approved, your medical aid provider will allocate a fixed number of psychology sessions that they'll cover. This usually depends on the diagnosis that the treating psychologist gave you.

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Let's Recap

1. You book your first appointment.

2. You pay for your first appointment either in cash, or we can claim from your medical savings, if available.

3. If your diagnosis meets the requirements, we send in the application.

 

4. Once approved, we'll claim directly from your medical aid's PMB for any follow-up sessions.

Note that your PMB only covers a certain amount of treatments per year, and once depleted, you'll have to either pay yourself or we can continue to claim from your medical aid savings, if available

RIVONIA

Call or WhatsApp: (+27) 066 259 1627

MENLYN

Call or WhatsApp: (+27) 066 215 9148

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Services we offer

We provide Psychotherapy in

English & Afrikaans

 

Sessions are 50 minutes in duration, with the following 2 rates:

 

  • Cash Rate

= R1,030 (Payable on the day)

  • Medical Aid Rate

R1030 (Covered by Medical Aid)

+ R170 Admin Fee (Payable on the day)

= R1,200

When making your booking online, please add your medical aid detail in the provided space so that we can check for pre-approval. Check Now

RIVONIA

Call or WhatsApp: (+27) 066 259 1627

MENLYN

Call or WhatsApp: (+27) 066 215 9148