As with most medical conditions, there are numerous treatment options available to someone who has been diagnosed with a mental disorder. However, most people don’t understand how medical aids can help. This is especially true for schizophrenia – a complex disorder that affects a person’s ability to think clearly, form cohesive thoughts and function in social environments.
Symptoms include delusional behaviour, hallucinations, confused thought patterns, odd and random movements, and unusual posture. Unfortunately, these symptoms often affect a person’s ability to stick to a medication routine, which is why a monthly injectable has been developed. The injectable comes with many benefits.
It must be prescribed by a healthcare professional, which allows a doctor to monitor the patient’s progress. This way it is easier to determine whether the person is keeping up with their medication schedule. The long-acting injectable also means that the risk of rehospitalisation is substantially lower, allowing the person with schizophrenia to lead a fulfilled life.
Loved ones often want to know whether treatment is covered by their medical aid. Schizophrenia is part of the prescribed minimum benefit (PMB) list of the Council of Medical Schemes (CMS). It stipulates that the payment of injectables be covered by all medical aids.
Alfred*, for example, is a 38-year-old man with schizophrenia. After being diagnosed at age 35, he was placed on oral medication that seemed to help him. However, he struggled to remember to take it daily and started to experience some of symptoms again.
His psychiatrist recommended the injectable medication and proposed that he submit a motivation to his medical aid to cover it. The process was simple. He contacted his medical aid provider and requested authorisation of a PMB to be allocated. His medical aid required a letter from his doctor, along with the prescription. After approval, his treatment became part of his chronic medication benefit.
As with most mental illnesses or disorders, it is possible to manage the symptoms with the correct medication, which medical aids often do cover. Speak to your healthcare provider to learn more about treatment options and contact your medical aid provider to discuss your cover options.
*Name changed to protect the individual’s identity.