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:


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.

How to help the thousands displaced by Masiphumelele fire

How to help the thousands displaced by Masiphumelele fire

Here's how to help the residents that were left displaced after Sunday's devastating blaze and are now trying rebuild their homes.

Popular articles
[LISTEN] Cervical cancer is the only cancer that is caused by sex - Dr Eve

[LISTEN] Cervical cancer is the only cancer that is caused by sex - Dr Eve

Dr Eve discusses cervical cancer and how it can be prevented.

Angry customer stops at nothing to expose bad service at upmarket hotel

Angry customer stops at nothing to expose bad service at upmarket hotel

Khabazela shares some of the most popular tweets, posts, and videos on 'What's gone Viral'.

Motorist who killed two goslings has been identified

Motorist who killed two goslings has been identified

According to the SPCA, he will be charged with contravention of the Animal Protection Act.

Gift of the Givers' Dr Imtiaz Sooliman – angel amongst men – talks about money

Gift of the Givers' Dr Imtiaz Sooliman – angel amongst men – talks about money

"I have no desire for clothes. I have no desire for holidays. I have no desire for outings. All I see is the suffering of people…"

Group distances itself from N2 car spinners caught on film

Group distances itself from N2 car spinners caught on film

It turns out that the petrol heads who span cars on the N2 were part of the SA Torque Cape Town Breakfast Run.

Uber customer threatened with hockey stick by driver

Uber customer threatened with hockey stick by driver

An Uber customer shares how she was threatened by an Uber driver with a hockey stick after a disagreement.

Here's how to check your load shedding schedule in Cape Town

Here's how to check your load shedding schedule in Cape Town

Residents are urged to take note of the schedules as Stage 1 load s​hedding remains a possibility.

3 emergency numbers you should have on speed dial and how they work

3 emergency numbers you should have on speed dial and how they work

These are the emergency numbers you should have on your cellphone and this is what you must understand about how they work.