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Discovery reverse refusal to pay in full for telephonic and virtual psychotherapy 

Discovery reverse refusal to pay in full for telephonic and virtual psychotherapy 
Maverick Citizen has attempted to get clear answers from providers over the past week on what they pay for and their motivation for not paying in full for virtual consultations.

Discovery Health Medical Scheme, South Africa’s largest medical aid provider, has made a U-turn on its widely criticised decision to pay less for virtual mental health consultations. However, Medscheme is sticking to their guns and paying reduced rates.

  • Maverick Citizen published an earlier version of the story saying Discovery continued to dither over whether to pay for virtual and telephonic consultations. This was based on information from psychologists and a delay on the side of Discovery to clarify. Discovery has now clarified their position.

Maverick Citizen has attempted to get clear answers from providers over the past week on what they pay for and their motivation for not paying in full for virtual consultations. This came after many psychologists and psychiatrists spoke out about the cuts, although they had to remain anonymous for fear of being targeted in future.

Maverick Citizen was informed last night that the Psychological Society of South Africa met again with Discovery Health yesterday (Tuesday) afternoon and “we are relieved to feedback that DHMS (Discovery) heard our concerns and have been able to recognise the arguments put forward which outline the ways in which the practice of teletherapy differs substantially from online consultation in other disciplines”.

It was confirmed that Discovery had agreed to reimburse online therapy at 100% of the usual rate. “This will, however, be subject to the establishment of quality parameters which would need to be submitted alongside an online claim. As we explained last week, the original document which had been suggested by DHMS has been recalled and a new document which is more aligned to our profession will be created,” a source said.

Psychologists said they were now working with Discovery to come up with something workable in the short-term which will not compromise patient confidentiality. Until such time that Dr Connect, Discovery’s online platform, is available, psychologists and psychiatrists are able to use other platforms such as Zoom and Skype.

Discovery also initially asked to see session notes from psychologists before the patient or therapist will be reimbursed.

In response, Discovery said that “the supporting clinical information of such a session would typically be fully provided for in a secure way through Dr Connect and Health ID, where patient data is safely stored. 

“Therefore as an interim measure, psychologists were asked to provide high level overview in a consultation note, not containing any clinical information, but is instead a verification of the session.”

However, after speaking with a number of psychologists and psychiatrists, Maverick Citizen confirmed that the initial request did ask for clinical information. 

Psychologists would have been required to fill out a form, which asks for details about the patient’s concerns and views about the problem or condition, the practitioner’s observations and interventions, the practitioner’s assessment of the patient, and the treatment plan for the patient.

The request for such notes has been reversed by Discovery in response to the outcry by psychologists.

On the form, which is titled “Allied, Therapeutic & Psychology Telehealth and Virtual Consultations Note”, Discovery states that “this document will be used to confirm appropriate funding for telehealth interactions. If this form is not filled out, Discovery will not release the funds and members will be liable for payment”.

Psychologists said it is hoped that the new structures will be in place by next week sometime. 

Earlier this week Discovery said that they will only pay 65% of the funds claimed by practitioners, 35% less than the published 2020 rates. These funds will come from a member’s day-to-day benefits.

Virtual or telephonic consultations may sound like an easier work load, however, psychologists say that the opposite is true. “Remote therapy is different to face-to-face therapy because we do not have access to as many cues as we do when in the room with someone, and the relational quality is more challenging.

“This means that we in fact work harder than ever to read and assess the patient, minute by minute as the session progresses. Sessions are not less intense or meaningful, and the same work is being done, but it is a lot harder. This is the feedback we are receiving from many people who are aghast at the way in which rates are assigned for remote work,” says a psychologist who would like to remain anonymous.

Discovery’s initial directive to slash their reimbursements would also have impacted on other medical schemes. A clinical psychologist, who asked to remain anonymous, said that: “Discovery is the administrator for a number of medical aids, which means that their decisions impact other medical schemes.

“Medscheme is another large administrator of medical aids and they have also acted in a way which impacts members and practitioners directly. While Discovery is paying 65% [now 100%] of the usual session rate, Medscheme have cut it even more drastically and are now paying the equivalent of a 15-minute consult.

“Medscheme implemented this retrospectively back to 15 March, which means that March accounts are also impacted.”

Mental health care professionals are losing money and the mental health of patients who cannot afford to pay out-of-pocket is at risk because of the decision to not fully fund virtual and telephonic consultations, according to a psychologist.

“There is widespread attrition of clients and many practitioners are reporting that they have lost significant portions of their practices. This is for a few reasons including the following: many clients feel uncomfortable moving to a remote platform,” says a clinical psychologist.

The lockdown has had a significant economic impact on many individuals who find themselves unable to work and receive a salary. As a result, mental healthcare workers are cutting expenses where they can. “Many practitioners are carrying clients by offering pro-bono or vastly reduced rates.”

Psychologists say that since the lockdown, they have seen a vast increase in the need for their services. However, many are working together nationally to offer pro-bono services to healthcare workers in public and private hospitals and clinics.

The South African Depression and Anxiety Group (Sadag) earlier also expressed their concerns about the issue of confidentiality and the decreased funding. However, they confirmed last night that they were confident that an agreement had been reached with Discovery.

Medscheme confirmed earlier today that they will be holding a meeting with stakeholders to decide on possible solutions.

Other medical aids, such as Momentum, have not (yet) said whether they will implement reduced funding for telehealth. DM/MC 

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