EPASSA PULSE (2) - KEEPING YOU UPDATED, INFORMED AND CONNECTED

October 31, 2016

 

There are just two weeks to go until the court case in which EPASSA will be represented as an amicus curiae in the Cape High Court. We call on all our members to assist us.

                                 

  •         Financial support to uphold court SOP and Medical Aid debacle:  Please contribute R450 for 2017 fees by Friday 11 November so that we can pay for our lawyers to travel to Cape Town to represent us in the High Court. We have thus far spent over R 150 000 in legal fees and expect significant, further fees. Our attorneys have kindly agreed to allow us to pay after we have raised the funds, which we shall do through membership fees, workshops and a 2017 conference.

 

Urgent plea: reminder for unpaid 2016 membership fees to cover legal fees in the vital court case scheduled to run from 14 to 17 November.

 

The EPASSA Workshop/ Conference Committee will meet this week to plan our 2017 conference. A great deal of effort goes into planning such an event and EPASSA is grateful to everyone who will be involved. We will announce the dates for our two-day conference soon.

 

Upcoming event:  * Workshop on IEB concessions - 26 November.

 IEB Concessions: A basic work shop on the process of assessment (IEB requirements, test battery, triangulation of data) and an approach to report writing (triangulation of information, case discussions).

                                          CPD points will be applied for.

                                          Presenters: Dr Tania Holz and Vicky Downing

                                          Time: 09:00 to 14:00

                                          Cost: R 550

                                          Venue: Epworth Children’s Village

                                                      47 9th Avenue

                                                      Extension 1

                                                      Lambton

                                                      Germiston

 

 

If you would like to attend the workshop please e-mail Tania attaniajholz@telkomsa.net.

 

Please support this initiative. Your fees will go toward the legal effort.

 

Medical Aid Flash Updates:

Three of the psychologists who are on the Discovery Psychology Panel met with Discovery regarding Discovery's recent letters to some psychologists. It was a productive meeting during which Discovery confirmed that they do not differentiate between categories of psychologists and that Discovery is increasingly aware of the value of psychological treatment. 

In terms of the letters to psychologists, Discovery highlighted the fact that these are sent out by the auditing department, whose responsibility it is to highlight unusual cases and the auditing department functions separately to the clinical department. The auditing department sits within the Holdings Company and although they consult on clinical input from Health, they function independently. They acknowledge that communication can always be improved and that steps will be taken based on the feedback received to enhance the communication and avoid areas of that could be unclear. 

They also noted the fact that the whole of the medical insurance industry has been under significant financial stress for the past year and having to look at ways to ensure the most appropriate allocation of funding to achieve the greatest possible benefit and cut increasing unnecessary expenses so that they can fund critical illness. This perhaps explains other medical aids beginning to discriminate against Educational and Counselling Psychologists in the sense that it may be purely a financial decision. Discovery is specifically concerned about a minority of medical professionals who appear to be over servicing medical scheme members, and also a trend that they are observing where medical professionals working with cases are not communicating with one another, leading to fragmentation of care.

Discovery confirmed that psychological assessment is critical and that they have no issue with funding this if clinically appropriate and indicated. The problem in the past may have been the primary ICD-10 code used for assessment. Discovery will explore this and revert back with additional insights. 

In terms of the letter regarding in-hospital referral for psychology treatment - the Discovery team communicated that this was meant as an attempt to promote a multidisciplinary approach, but that they still recognize that psychologists do not require a doctor's referral to treat patients, but state that it is optimal that Doctors direct care in hospital especially as it pertains to elements of medical management. They are in support of communication and care coordination from multidisciplinary teams to prevent over servicing of patients. Their request is to indicate the consulting doctor on any in-hospital claim as from 1 November.

 

  •         Bonitas have announced that they will no longer cover Educational Psychology for over 21’s

 

  • Medihelp have announced that as of 1 November 2016 they will no longer consider services rendered by Industrial and Educational Psychologists for benefits on any benefit options.

 

  •         The South African Human Rights Commission (SAHRC) has received EPASSA’S complaint against the Council for Medical Schemes, which EPASSA believes is colluding with medical aid discrimination against educational psychologists. The SAHRC has accepted that the matter falls within its mandate to investigate, and is waiting on the CMS for a response.

 

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