Certain medical aids pay for Therapeutic Reflexology treatments, but certain basic requirements should be in place; learn more in today’s post.
Therapeutic Reflexology is a recognised healthcare profession in South Africa and as such is covered by many medical aids. However, for medical schemes to pay for Therapeutic Reflexology, there are certain requirements that must be adhered to, for example:
- Therapeutic Reflexology is covered by medical aids, not merely reflexology. The difference is in the fact that Therapeutic Reflexology is practiced by a formally registered and regulated healthcare professional while reflexology is often used within the beauty industry, which is not covered by medical schemes.
- The Therapeutic Reflexologist must be formally qualified with a 2-year Diploma in Therapeutic Reflexology from a training institution registered with the Department of Education, the South African Qualifications Authority (SAQA), and recognised by the Allied Health Professions Council of South Africa (AHPCSA). No short courses are accepted. Any overseas qualifications must be scrutinised by the AHPCSA before allowing such a therapist to be acknowledged and registered in South Africa to practice.
- The Therapeutic Reflexologist must be formally registered with the AHPCSA. The AHPCSA is a statutory healthcare council regulating the profession of Therapeutic Reflexology in South Africa and it is mandatory to be registered with the AHPCSA to practice, just like medical doctors must be registered with the Health Professions Council of South Africa (HPCSA) to practice. Practicing without being registered with the AHPCSA is illegal and may result in the therapist being prosecuted for practicing without a license. No other organisation can offer statutory council registration and therefore AHPCSA is compulsory.
- To make medical aid reimbursement possible, the Therapeutic Reflexologist must also have a valid practice number obtained from the Board of Healthcare Funders (BHF), the same organisation issuing practice numbers for medical doctors. Without a valid practice number, medical aids do not reimburse. A practice number can only be obtained if the Therapeutic Reflexologist is properly qualified, completed the necessary practical training, and is registered with the AHPCSA.
- The Therapeutic Reflexologist must provide properly structured invoices and statements containing the practice number and the correct procedure codes and ICD-10 codes for the treatment.
It is imperative to only make use of properly qualified and AHPCSA registered Therapeutic Reflexologists with valid practice numbers to claim from your medical scheme.
Just because the Therapeutic Reflexologist complies with all the above-mentioned requirements, does not mean that your medical aid will fund the treatment, because:
- It depends on whether your medical scheme funds Therapeutic Reflexology. It is the responsibility of the patient to find out if their medical scheme covers Therapeutic Reflexology. At this stage, there are more than 14 medical schemes paying for Therapeutic Reflexology.
- It depends on the plan/option that you are on. Just because a specific medical scheme pays for Therapeutic Reflexology, it does not mean that your specific plan/option covers it. It is the patient’s responsibility to find out if their medical aid plan/option covers Therapeutic Reflexology.
- Medical schemes usually pay Therapeutic Reflexology from the savings portion of the medical aid; if your savings are depleted, then it will not be covered.
Some medical schemes do not cover Therapeutic Reflexology but instead of being open and honest with their patients about it, they reject the claim and then tell the patient that the Therapeutic Reflexologist used the incorrect procedure codes. The procedure codes for Therapeutic Reflexology are standardised so it is incorrect for a medical aid to state that incorrect codes are used. It has also been noted during the past year that a specific large medical scheme is constantly capturing procedure codes incorrectly as a five-digit number instead of the six-digit number provided on the invoice and then the claim is rejected based on incorrect procedure codes being used, but that is a quick fix as it usually just a phone call to tell the medical scheme once again that they captured incorrectly.
If all the above-mentioned matters are adhered to, medical schemes usually reimburse for Therapeutic Reflexology treatments. Every Therapeutic Reflexologist works differently but very few submit the claim directly to your medical scheme; usually, you have to pay the Therapeutic Reflexologist and then the necessary paperwork is provided to the patient so the patient can personally submit it to their medical scheme for reimbursement.
What if my medical aid does not pay for Therapeutic Reflexology?
That is not the end of the world because you can pay for the treatment yourself, but usually, if you submitted the claim to the medical scheme and they reject it, it is still listed as a healthcare expense on your medical aid statement for which you may claim it back from your personal income tax at your financial year-end.
Even if your medical aid does not pay for Therapeutic Reflexology, you can pay for the treatment yourself as it will be worth it as it benefits your overall health and wellbeing and treatment cost less than a hairdressing appointment, or less than a tank of petrol, or less than a meal for your family at a good restaurant. Therapeutic Reflexology should not be seen as an expense, but rather as an investment in your health and wellbeing.
Invest in yourself and make an appointment for Therapeutic Reflexology!
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Christo A. Scheepers: Therapeutic Reflexologist
Dip.T.R.(Cum Laude) [IARAMT]
AHPCSA: A11945
Pr. No.: 1080000737453
Tel. 072-800 7243