FOCUS ON SPORTS MASSAGE: Two factors related to massaging sports participants, may jeopardise therapists’ and patients’ claims for reimbursement namely accurate use of professional title and lack of informed consent.
Therapeutic massage therapists treating athletes need to ensure that the correct designation of their qualification as it appears on the Allied Health Professions Council (AHPCSA) register is printed on their statements and stationery. The medical aid schemes will not reimburse the patient if the professional and legal title of the health care worker that appears on the statement is incongruent with that which is set out in the amendments to the Allied Health Professions Act No 63 of 1982 and the statutory council register. Neither will they pay out if the therapist fails to supply all information required by the Council for Medical Schemes.
Furthermore, as discussed in the article Sports massage in the South African legal and professional context (see previous article) the use of the term sports massage is illegal in as there is no register legitimising this title.
The possibility exists that a number of medical aid schemes may have a policy of not meeting costs for injuries sustained during some sporting activities as part of their standard cover. Since payment for specific services is at the medical schemes discretion, it is important that the individual medical schemes policies are clarified with the patient prior to the commencement of treatment. Since professional athletes’ income is dependent on the quality of medical treatment they receive if injured, they would most likely have made specific provision for their needs through extended or specific cover. The amateur athlete on the other hand, may not qualify for automatic reimbursement for the treatment of sports injuries. The therapeutic massage therapist should bring this information to the patients’ attention during the informed consent procedures to allow the patient to clarify the matter with their service provider in case they are reliant on the medical schemes meeting the costs of the treatment.
Now that practice numbers are being issued to therapeutic massage therapists, it is important that the patients’ right to claim from their medical aid service provider is upheld by the practising therapists. This means that if a therapist chooses not to apply for a practice number, they inform the patient of this anomaly prior to any cost being incurred to give the patient the opportunity to exercise his/her right to consult a therapist who has a practice number. Further to this a therapeutic massage therapist is obliged to present the patient with an account / statement that meets the medical schemes requirements for reimbursement.
It is important to also note from a professional service perspective, that unless a therapeutic massage therapist has been allocated a practice number by the Board Of Healthcare Funders, no medical aid scheme will reimburse patients for treatment costs incurred whether the treatment is sports-related or not. Therapeutic massage therapists who do not hold a practice number are legally obliged to inform the patient if they do not have a practice number and the implications thereof during the informed consent procedures.
Once tariff codes have been approved by the Council for Medical Schemes, both patient and therapist are legally entitled to negotiate whether the therapist charges medical aid rates or private rates for services rendered.
The Massage Therapy Association should be congratulated on embarking on the process of attaining the right for all patients who are members of medical schemes to claim reimbursement of their costs. It is important to note though, that reimbursement for specific high-risk categories such as sports massage is at the individual medical schemes discretion.