ALAN NIGEL PITCHFORD
This letter is now well overdue and I hope it finds you in good health.
With the current economic climate as it is I thought it may be a good idea to cover the subject of medical aids and osteopathy. If you are not on a medical aid, or are on a hospital plan only, you may want to stop reading this now. For those of you who are on a medical aid you will be pleased to know that more medical aids are paying for osteopathy. The payments are normally deducted from your savings.
In order for payment to be made each invoice must include an ICD-10 code, a tariff code and a tariff rate. Each tariff code is linked to a tariff rate. The tariff rates are set by the Department of Health and are listed on the National Reference Price List which can be found on http://www.doh.gov.za/docs/nhrpl-f.html . Although the tariff codes for osteopathy have been approved by the DOH, the tariff rates have still not been approved and need to be resubmitted. This is a lengthy procedure as it involves the co-operation of 80% of the osteopaths in the country, who each need to submit details of all their expenses and also be prepared to be audited by the DOH. The 2009 NHRPL was omitted from the first draft “with the DOH citing low respondent rates, changes to codes and RVU figures being fabricated as the reasons for rejection. Osteopathy subsequently furnished DOH with evidence of 100% respondent rate, no code changes and compliance with DOH regulations regarding the manner in which the RVU’s had been derived. The matter is still awaiting final decision by DOH.”
The Council for Medical Schemes, however, did circulate a letter in June 2005 stating:
1. Work is in progress to expand the NHRPL to provide new schedules for naturopaths, osteopaths and phytotherapists (BHF practice types 101, 102 and 103 respectively).
2. In the interim, we are satisfied that there is a reasonable degree of similarity between practice and cost structures of:
a. naturopaths and phytotherapists, on the one hand, and homeopaths (BHF practice type 008) on the other; and
b. osteopaths, on the one hand, and chiropractors (BHF practice type 004) on the other.
3. Until such time as new NHRPL schedules are put in place for naturopaths, osteopaths and phytotherapists, where medical schemes currently offer benefits for these disciplines but lack internal billing codes or other mechanisms for the processing of claims, we recommend that medical schemes allow:
a. naturopaths and phytotherapists to bill using the homeopath schedule of the NHRPL; and
b. osteopaths to bill using the chiropractor schedule of the NHRPL.
4. We understand that this is already the practice among some medical schemes. Nevertheless, the decision whether or not to follow this recommendation or to use alternative mechanisms at their disposal is a decision that medical schemes need to take themselves.
I hope this helps explain why there is often confusion when submitting claims to your medical aid. Some use chiropractic codes while others use osteopathic codes, and then some choose not to pay for osteopathy on the basis that the rates have not been approved. Then, of course, there are those that just do not even know what you are talking about! If you believe your invoice should be reimbursed by your medical aid and it has been rejected, please call to see if we can help. We have had different patients send exactly the same bill to exactly the same medical aid, one has been paid and one has not.
We do, however, have a certain amount of clarity with some of the medical aids and I have listed below those that do pay – depending on what option you have with them.
Sappi Medical Aid
Sizwe Medical Fund
Wooltru Healthcare Fund
Discovery – DO NOT PAY. The manual states that they do pay for Allied Health Professionals – but this is misleading as they do not pay for osteopaths.
There is a good chance that if your medical scheme is administered by Medscheme, Momentum, Metropolitan Health or Old Mutual, that it will pay for osteopathic treatments. Please be sure to check before you make your appointment if you depend on your scheme reimbursing you.
If you have had success with any other medical aid, I would be most grateful if you could keep me informed.
And finally, a health tip to help you cope with the stress experienced when dealing with your medical aid: take a good vitamin B complex. This will help calm the nervous system, aid digestion, improve your sleep pattern and benefit your overall energy levels. Additionally, stay mobile and consume within your calorific allowance.
Here’s to your good health!
PS: to view previous newsletters please visit our website.
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