Discovery bemoans well-off therapy claims

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.