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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 have 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.

Cost & Duration

Sessions are 51 minutes in duration, with the following 2 rates:

 

  • Cash Rate

R1,100.00

  • Medical Aid Rate

We charge the specific medical aid rate per session, which may be a different rate for each medical aid provider, with a minimum liable base value of R1,073.30. This means that, should your medical aid cover a cost which is below this base value, then you would need to pay our cash rate of R1,100.00, and claim back the allowed amount from your medical aid yourself.

 

+ R180 Admin Fee (Not Covered by Medical Aid)

Check if your medical aid will pay. Check Now

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