MEDICAL FUNDS CITE REGULATION
Psychologists hit as payments dry up
Nonclinical psychologists are closing shop in their droves because of a standoff with medical aids that refuse to pay for their services
Nonclinical psychologists are closing shop in their droves because of a standoff with medical aids that refuse to pay for their services.
The dispute stems from the scope of practice regulations that were introduced in 2011 but dismissed by the High Court in Cape Town in 2016.
The Recognition of Life Long Learning in Psychology Action Group, formed to fight for educational, counselling and industrial psychologists, said nonclinical psychologists were being forced to close practices at an alarming rate because of the scope of the regulations. The group will decide next week if it will take legal action against the schemes and the regulator.
Action group founder and chairman Dr Kobus Scholtemeyer said on Monday that most psychologists had been affected by medical aids’ refusal to pay for services rendered by nonclinical practitioners.
When the Health Professions Council of SA announced an amended scope of practice for psychologists in 2011, this was met with disappointment.
Although the regulations were dismissed in the high court in 2016, it gave a two-year grace period during which a more inclusive framework would be formulated. However, Scholtemeyer said not much consultation had taken place.
"The law that artificially differentiates between categories of psychologists is invalid. Medical schemes and the public should realise that first of all. Medical schemes cannot rely on that invalid law not to compensate psychologists," he said.
The Government Employees Medical Scheme (GEMS) is one scheme that will not pay nonclinical psychologists. Spokeswoman Liziwe Nkonyana said its lawyers were reviewing the documents in relation to the ruling by the high court.
Action group members identified MediHelp, GEMS, Bonitas, Profmed and Polmed as some of the schemes that did not pay nonclinical psychologists, citing the erroneous regulations.
Council of Medical Schemes spokeswoman Dr Elsabe Conradie said schemes were obliged to pay only for prescribed minimum benefits. Other benefits offered were self-insured and differed from scheme to scheme. "The scope of practice for educational psychologists, for example, states that the services are related to learning and development. If there is no benefit offered by a medical scheme for learning and development, we cannot force schemes to pay," said Conradie.
In a 2015 survey conducted by the Psychological Society of SA on medical aids, respondents said some medical schemes were not paying for certain psychological treatments.
Polmed, a closed scheme for South African Police Service employees, was cited by most respondents for not funding the services of educational and counselling psychologists.
In October 2015, Polmed issued a communiqué to educational and counselling psychologists indicating it would no longer pay them.
Educational psychologist Gerhard van Niekerk said: "Polmed and GEMS were 70% of my patients and they stopped paying me in November 2015. I still continue to service their members because they are old patients of mine and I can’t just drop them."
Van Niekerk used to conduct 240 sessions a month. Now he does 40 a month and does not know how much longer the schemes that do pay will continue to cover members.
In 2016, his business lost about R800,000, he said.
Van Niekerk is one of the only practising psychologists in Aliwal North and Burgersdorp in the Eastern Cape.
Van Niekerk, 65, who has been doing clinical work for more than 25 years, said: "I am prepared to do a year’s internship to register as a clinical psychologist but the policy doesn’t allow me to register for two categories and I don’t know why."
He said that in the training of psychologists, it must be clear that they could work only in the field in which they studied.
In the 2015 survey, psychologists reported having difficulty using the billing codes required by schemes, which resulted in a high rate of claims rejections.
Polmed offers coverage to members diagnosed with mental health conditions including depression, bipolar mood disorder, post-traumatic stress disorder, schizophrenia and alcohol and substance abuse.
However, Polmed does not cover claims relating to aptitude tests, IQ tests, school readiness tests, questionnaires, marriage counselling, learning problems and behavioural problems.
"If clinical psychologists do not generally treat children and the scheme does not cover payment for educational psychologists, what is meant to happen to the children of members who need help?" asked action group member and counselling psychologist Dr Kevin Fourie.
Industrial psychologist Hester Antoinette Barnard, who works mainly with correctional services workers, teachers and police officers, said the regulations had been devastating for her practice. She went from seeing nine clients a day to one or two a day.
Prior to the introduction of the regulations, psychologists could practise in their area of study and other areas in which they had experience. The regulations introduced a rigid framework, limiting psychologists to practise according to their qualifications irrespective of experience in other areas.
The Health Professions Council of SA could not be reached for comment.