News24

Frequent therapy visits in Joburg north, Cape

2012-01-26 12:23

Johannesburg - Well-off families in Johannesburg's north and the Cape Winelands undergo more therapy and claim for services that are not always medical, Beeld reported on Thursday.

Dr Jonathan Broomberg, chief executive of health insurer Discovery Health, said there were some families in these areas that used these benefits so often that the fund was forced to limit them.

The benefit is now between R4 000 and R21 000 a year depending on the plan. These were previously unlimited.

Service providers and members have complained about this, with some therapists saying they had seen a 30% drop in their Discovery Health clients.

Discovery figures show that some patients in Johannesburg's northern suburbs have seen speech therapists and audiologists more than 17 times a year, compared with the rest of their members' less than five visits.

Parents in these areas visit occupational therapists over 12 times a year, compared with nine by members in other areas. Visits to physiotherapists, psychologists and biokineticists are also higher.

One 32-year-old patient claimed for three sessions a week with a biokineticist in 2010.

Another racked up R46 000 for two visits a week to a physiotherapist for stress headaches.

In 2010 one child saw an occupational therapist 156 times to strengthen hand grip.

Broomberg said he was not questioning the therapy itself, but whether medical aids should have to pay for it.

"Overseas, no health plan pays for long-term therapy to help a child with his pencil grip," he said.

Comments
  • Jacques - 2012-01-26 12:31

    if its stated as benefits on yoru plan, which you are paying for, then dont complain !

  • Maximus Odinidus - 2012-01-26 12:32

    Seems medical aid slush fund is getting a little lean and now they have decided not to pay for certain services. Sort of like the Vodacom debacle. It's no longer money for jam.

  • Grimmister - 2012-01-26 12:35

    Yes Mr Broomberg...Medical Aids should pay for all the benefits they offer their clients...as they inadvertently pay for that service by paying their monthly subscriptions...is that not the way the Medical Aid Business should be run?

  • John - 2012-01-26 12:44

    Johannesburg - Health insurer Discovery Holdings [JSE:DSY] on Thursday reported a 32% increase in its operating profit to R2.838bn for the year ended June 30 2011. Normalised headline earnings per share increased by 31% to 365.8 cents, with the group's embedded value per share growing 19% to R48.45. Gross inflows under management grew by 21% to over R50bn. Wow..... cut the benefits and next year you can line your pockets even more.....

      procold2 - 2012-01-26 13:04

      exactly what they going to do, they did it last year and will next year,its called legal robbery and is not punishable by law. Its not a medical aid anymore its a medical must have and they can dictate the terms.

  • Nurse - 2012-01-26 12:53

    What a ridiculous article. We don't the facts behind these "statistics" so we can't draw a conclusion as to whether the number of visits are warranted or not. Every person has different needs based on their circumstances. Boo hoo Discovery, try for sympathy some place else, we're all out today!

  • Callie Hugo - 2012-01-26 12:54

    Some people have osteoarthritis and needs atleast one or two sessions a week to manage their pain! No medication will mskr a difference and thus the only way to vontrol it is physio! U need to see s biokineticist atleast three times a week for atleast two months to really make a longterm difference! We pay medical aids so much but they are so full of nonsense when it comes to fullfilling their part of the deal!

  • Trevor - 2012-01-26 12:56

    WOW..this is rich, coming off the back that Discovery is making HUGE PROFITS...understand if it was running at a loss so stop whining and preparing people for a hike in premiums...you spending WAAAY to much time with the ANC learning their tricks...hitting us with this to justify hikes coming...

      Trent Hodges - 2012-01-26 19:49

      Non Profit- There profits are from their share price, and lucrative life insurance...

  • Trish - 2012-01-26 13:17

    I find the explanations from the scheme unacceptable! It seems that only certain members are targeted, without apparent consideration of the deeper background of medical treatments. All the treatments quoted do not seem to consider major medical conditions or injuries! When these explanations are given and then in the same breath it is said that the treatment is not being questioned is an absolute contradiction! The extreme measures that have been taken is really over the top, going from unlimited benefits to overly restricted limits. And then premiums are increased by 8 or more %. What are forensic departments for, if they dont include individual investigation on selected members. Previously it has been said that this use is not by the majority of members, so why the need for restriction which has led to this whole debacle?

      Trent Hodges - 2012-01-26 19:48

      7.9%

  • ludlowdj - 2012-01-26 13:24

    Medical aids like insurance are nothing more than money making rackets. The ever increasing costs and fees result in member's making sure they get as much rand value out of their subs as possible while the schemes do their best to pay out as little as possible. Unless you are unfortunate enough to have an ongoing chronic health problem, it is a lot less expensive to simply put the money you would pay in subs into an account and use it as and when necessary, I have found that doing this not only reduced my annual medical costs by nearly 80% but it also leaves me with a large pot of emergency money that earns me interest and allows me to confidently face any and all financial challenges, I have done the same with my car insurance and once again am making incredible savings.

      Trent Hodges - 2012-01-26 19:48

      Until your in hospital after a car accident and your "pot" is used up in an hour on the operating table...

  • Schmee - 2012-01-26 13:42

    So two groups of people are misusing the scheme and everyone has to suffer. And did they check why these people need more therapy? If I lived in Sandton I would definitely have a more stressful life.

  • clivelang1 - 2012-01-26 13:43

    Mr Broomberg, instead of limiting all your members benefits because of the high usage of some, why don't you investigate the high usage to see if its warranted and work from there, instead of making decisions that affect all Discovery clients. If those claims aren't warranted deal with those people and leave the rest of us alone.

  • tspamela - 2012-01-26 13:46

    its quite simple vote with your money - change to another "medical aid" company loss of a couple million paying customers works wonders- just as we need cover they need funding works both ways. "medical aids" should take it up with those who abuse the system not punish others

      paulmandlankosi - 2012-01-26 16:27

      They are all the same

  • StirMonger - 2012-01-26 13:51

    What a pitiful bunch of excuses. If you can’t pickup & deal with specific patients & specific service providers then you shouldn’t be in business. You have the power & right to cancel agreements with both in the event of fraud. I believe this to be case of more in less out. By the way, what is going to happen to all the millions that are going to be saved? I suppose the “administrators” are all going to get performance bonuses. I would suggest that employees chase their companies to change MA's immediately. It’s not a case of not needing 200 visits for pencil grip, but you won’t get a torn knee ligament fixed in 15 visits.

  • Thelma - 2012-01-26 14:19

    That is why we pay a premium to Discovery on a montly basis to receive these benefits.....besides if the rich are abusing the benefits why should the rest of us suffer? crack down on the guilty parties!!!!

  • Trent Hodges - 2012-01-26 19:46

    Incase no one knew- Medical Aids are no profit organizations, and Dr Bloomberg was stressing the fact to protect the Fund from abuse...

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