Claims with regard to Telemedicine

Dear CPF members,

This is an important information update with regards to claims submitted if you intend to engage in telemedicine/e-counselling processes.

According to our latest information you need to keep in mind that schemes might not pay for e-counselling/telemedicine processes. The telecon code 0130 is reserved for psychiatrists at this stage at Discovery, so currently we do not know if they will pay, even on drconnect.

We have reached out for further information but until we get such information from Schemes, it is better to assume they will not pay. The patient would have to be informed as such and it should be recorded (via the video meeting or through e-mail confirmation) that they are aware of this and agree to this. Also, at this stage, the HPCSA does not make provision for new patients on telecom, only existing patients. Patients may not be diagnosed via telemedicine. Medical Schemes will follow this approach from a funding point of view, if they fund at all.

PLEASE NOTE: If a scheme funds a claim for a Psychology consult done via e-counselling/telemedicine, it may be because they are not aware that the consult did not happen face to face . Such moneys may be clawed back at a later stage if the scheme discovers it was an e-counselling/telemedicine consult. Do not assume that a paid claim for e-counselling/telemedicine was paid correctly by the scheme. They do not know it was a e-counselling/telemedicine Consult, as the code usage implies face to face consult, even if the descriptor is changed manually.

Another aspect to consider is that unless the HPCSA changes their rules on telemedicine, your Malpractice Insurer is UNLIKELY TO PROVIDE YOU WITH MEDICOLEGAL INDEMNITY COVER FOR E-CONSULTATIONS. The insurer will judge you according to existing regulations and if the HPCSA does not change the regulations, your insurer will consider your conduct as unlawful and will therefore not cover you for e-consultations. Each practitioner would have to weigh up the risks of contracting coronavirus in face to face consultations against the medicolegal risk of not having indemnity cover when conducting e-consulting. Patients (or their families) can also not be requested to sign away their right to institute a malpractice claim, as such a contract proviso would not stand up in court.

We will update you as soon as we have more clarity from the schemes.

Kind Regards

Clinical Psychology Forum