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Are you covered for your mental health?

Nov 4, 2022

Earlier this year, news24 reported that South Africa was ranked among the lowest on a mental health wellbeing scale composed by Sapien Labs for Annual Mental State of the World Report. The publication also reported that as many as one in six South Africans suffer from anxiety, depression, or substance-use problems. Moreover, according to the South African Depression and Anxiety Group (SADAG), only 27% of South Africans reporting severe mental illness ever receive treatment. In other words, almost three quarters of those suffering from mental illness do not receive any mental health services.

The high cost of psychological and psychiatric treatment is the prime reason that most people do not receive healing for their mental health issues. This is why it is important to ensure that when you choose a health insurance or medical aid plan, you make certain that it includes a mental health benefit. While mental health treatment used to be mostly excluded from health insurance and medical aid plans, in recent years the terms have changed and certain conditions such as bipolar mood disorder and schizophrenia are now classified under prescribed minimum benefits (PMBs) for all plans as per the Medical Schemes Act.

Other mental health conditions that are listed under PMBs that are mandatory to cover regardless of the patient’s plan, include Acute delusional mood, anxiety, personality, perception disorders and organic mental disorders caused by drugs; Alcohol withdrawal delirium and alcohol intoxication delirium; Delirium caused by Amphetamine, Cocaine, or other psychoactive substance; Acute stress disorder accompanied by recent significant trauma, including physical or sexual abuse; Attempted suicide, irrespective of cause; Brief reactive psychosis; Major affective disorders, including unipolar and bipolar depression; Schizophrenic and paranoid delusional disorders; Anorexia Nervosa and Bulimia nervosa; and Treatable Dementia.

Each condition however has its own set of limitations. Treatment for depression for example, only mandates schemes to fund in-hospital treatment for up to 21 days or up to 15 outpatient therapy sessions a year. Admissions can be consecutive or split up in a several different ways. However, the medical scheme may require motivations for approvals if there are multiple short admissions over a short period of time. Some providers, especially health insurance companies might also stipulate that patients receive their treatment only from specified network doctors, specialists, and hospitals and not cover the costs if the patient uses one outside of the predetermined network.

To ensure that you are duly covered there are a few pointers to consider, including checking to see whether your coverage uses provider networks, asking about co-payments, asking about your deductible needed to pay out-of-pocket before your health insurance makes any payments, and finally, find out from your doctor or institution whether or not they accept your insurance and what their terms for this is. Mental health is a process not a destination. This is why it is crucial to ensure you have the right cover to cater to these needs.

“What mental health needs is more sunlight, more candor, and more unashamed conversation.” — Glenn Close