Living with diabetes is tough – we all know that. But if you need to see someone for diabetes burnout or depression (or any other reason), how can you get your medical aid to cover a psychologist?
Who should think about seeing a psychologist?
If you are feeling any sort of emotional distress that you don’t feel able to cope with alone, it is definitely worth seeing a psychologist. Anxiety and excessive sadness (or depression) are common reasons for seeking help. Addiction is another.
Psychologists can help in various ways – therapy is not just for people with diagnosed psychiatric conditions. Difficult emotions can affect us physically, and not just emotionally.
If you have a medical condition (such as diabetes) that you are struggling to manage because of emotional stress, seeing a psychologist is definitely a good idea.
Daniel Sher, clinical psychologist
Is it possible to determine how many sessions will be necessary?
This can vary widely. The number of sessions required depends on factors such as your personality, your diagnosis, your therapy goals and the modality (or way of working) that your therapist uses. While some people get symptom relief in as few as 5 to 6 sessions, others require years of therapy in order to effectively manage their mental health.
How do you get your medical aid to cover the sessions?
All medical aid members (regardless of your provider or plan) have access to cover for chronic conditions, known as Prescribed Minimum Benefits (PMBs). Even for those on the most basic of hospital plans, these benefits should apply. However, only people who have been diagnosed with certain chronic mental health conditions (such as major depressive disorder or bipolar disorder) are able to access these benefits for therapy sessions. PMBs are typically not available to people who have not been diagnosed with one of the specified mental health conditions.
We unpack what PMB benefits are here.
Daniel Sher, psychologist
If you qualify for PMB cover, you will need to speak to your mental health provider about applying for cover.
Is there a specific ICD-10 code? Do you need pre-authorisation?
The first thing to do is meet with your provider (psychologist) at least once so that they can establish your diagnosis and ICD code. They will then need to submit an application for cover to the medical aid. The process of applying for PMB cover varies across different medical aids. At times, a written motivation letter will be required. Ask your psychologist or psychiatrist about the best way forward.
Many mental health practitioners do not claim directly from medical aid, meaning that you need to settle sessions directly and then claim back from your insurer. Your therapist can still, in these instances, assist you in applying for cover from your medical aid. It is a good idea to discuss this arrangement during or ahead of your initial consultation.
Unfortunately, at this point in time, having diabetes does not guarantee access to mental health cover. This is unfortunate because we know that people with diabetes have greater mental health needs; and that addressing these needs help with diabetes management.
Untreated emotional distress in people with diabetes leads to a huge increase in physical health problems and massive healthcare expenditure, despite the fact that many mental health conditions are easily treated.
Daniel Sher, clinical psychologist
Ideally, having diabetes should entitle one to a certain number of preventive / supportive mental health sessions. Advocacy is needed in this area.
What can you do if you aren’t on medical aid?
Unfortunately, the mental health needs of the majority of our population go unmet. This is especially true for people with diabetes. While it can be tricky to access state services, they do exist and many of our existing state mental health care workers provide an exceptional level of care. Keep in mind that psychologists and psychiatrists are not the only ones who can help: social workers, psychiatric nurses, registered counselors and NGOs may also be able to assist.
Here’s a link that explains how to access mental health services in the public sector.
More about Daniel Sher
Daniel is a clinical psychologist with a special interest in diabetes-focussed therapy, having lived as a Type 1 for over thirty years.
Daniel works form Cape Town, but also offers sessions online.
Find out more at www.danielshertherapy.com
What to read next?
What to do during diabetes burnout: diabetes coaching: Our recent Ask Me Anything (AMA) event about diabetes burnout discussed this topic exactly – you can watch the recording of it here, if you’re interested.
How to help during diabetes burnout: Diabetes burnout is unavoidable, when you’re living with diabetes. But how can you help during diabetes burnout? What can you offer someone you love who is struggling?
What’s the best medical aid for diabetics?: We asked Diabetic South Africans to vote on the best medical aid for people with diabetes in South Africa – and why. Medical aids can be really difficult to choose, so we thought it would be helpful to hear from the community what works for them.
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