Prescribed Minimum Benefits (PMBs) refer to a set of health services that medical schemes must cover as part of their statutory obligations. These benefits are meant to ensure that members of medical schemes have access to necessary medical care for certain conditions, regardless of their specific medical plan..

For speech therapy, PMBs cover certain speech and language conditions, but the exact coverage may vary depending on the medical scheme and the condition being treated.

General PMB Coverage for Speech Therapy:

• Speech therapy is typically covered under PMBs if it is required to treat prescribed minimum benefit conditions such as speech and language disorders related to conditions like stroke or traumatic brain injury.
• Medical schemes must provide coverage for rehabilitation services, which can include speech therapy, when needed to treat these conditions.

To determine if you qualify for PMBs for speech therapy:

1. Confirm the condition: Your speech therapy treatment should be linked to a PMB-qualifying condition, like a neurological disorder.
2. Consult with your medical scheme: Contact your medical scheme directly to confirm the specific coverage details for speech therapy. The scheme may require prior authorization or approval for certain treatments.
3. Check scheme rules: The benefits provided may depend on your specific plan and its rules, so reviewing your scheme’s guidelines will be helpful.

If you believe that you meet the criteria for a PMB-covered condition but are facing difficulties with your medical scheme, you may appeal or request an independent review through the Council for Medical Schemes (CMS).

The practice charges medical aid rates, as prescribed by the Board of Healthcare Funders (BHF) of Southern Africa. Different medical aids pay different rates, and therefore rates differ, depending on your specific medical scheme. Please refer to the document below regarding the practice rates for all aspects that could relate to your speech therapy.  sessions. See pricing here.

The potential for an adult patient to make progress with speech therapy after a neurological incident (such as a stroke, brain injury, or neurodegenerative condition) depends on several factors. While each case is unique, there are key aspects that influence recovery and progress in speech therapy:

Extent of Neurological Damage

• Severity of the Incident: The degree of impairment caused by the neurological event plays a major role. Patients with mild to moderate brain injuries or strokes may experience significant improvement with therapy, whereas those with severe damage may face more challenges and require long-term therapy, with recovery being slower or less complete.
• Location of Injury: The area of the brain affected determines which aspects of speech, language, communication and/or swallowing will be impacted. For example, damage to the left hemisphere, which controls speech and language in most individuals, can lead to aphasia or verbal apraxia, while damage to other areas might affect cognitive aspects of communication or motor speech skills.

Time Since Incident

• Early Intervention: Early access to speech therapy generally yields better outcomes. Neuroplasticity (the brain’s ability to reorganize itself after injury) is highest in the weeks and months following a neurological event. Engaging in therapy as soon as the patient is stable can help maximize the potential for recovery.
• Chronic Stage: As time passes, progress may slow down, but significant gains can still be made, particularly with consistent therapy and tailored interventions.

Patient’s Age and Overall Health

• Age: Younger patients often have a greater capacity for neural recovery due to greater neuroplasticity, although older adults can still make substantial progress with the right intervention.
• General Health: A patient’s overall physical and mental health significantly affects their ability to participate in therapy and engage in rehabilitation. Pre-existing conditions such as Dementia or other cognitive disorders may complicate recovery.

Cognitive and Motivational Factors

• Cognitive Function: If the patient’s cognitive abilities are largely intact, they are more likely to make progress in speech therapy, as understanding and following instructions is a key part of the process.
• Motivation and Engagement: Patients who are motivated and actively participate in therapy sessions are generally more likely to make progress. The patient’s mental attitude and support system can also influence their recovery.

Therapist’s Approach and Therapy Techniques

• Individualized Therapy: Therapy that is specifically tailored to the patient’s needs, taking into account the type of impairment and disorder, the patient’s goals, and the resources available, is critical.
• Consistency and Duration: Consistent and ongoing therapy over an extended period often leads to more significant improvements. The frequency of sessions and exercises performed outside of therapy are also important factors.

Support systems

• Family and Caregiver Involvement: The involvement of family members and caregivers in supporting the patient’s therapy, whether by helping with daily exercises or providing emotional support, can make a significant difference in the speed and extent of progress.
• Social Environment: A supportive social environment can provide additional motivation, as opportunities to practice communication in real-world settings can enhance recovery.

In summary, a patient’s ability to make progress with speech therapy following a neurological incident is highly individualized and depends on factors like the severity of the neurological damage, the location of the injury, time since the incident, overall health, motivation, and the therapy plan. While many patients can experience meaningful improvements with the right therapy and support, the extent of recovery may vary. Early, targeted intervention, along with active patient participation and a strong support system, tends to yield the most favourable outcomes.

The practice provides home-based speech therapy, in the Northern Suburbs of Cape Town, for patients who are immobile due to their injury or are unable to come to the practice’s rooms. Therapy in the comfort of your own home can be arranged at the practice’s discretion. Home visits however incur an additional cost. Some medical aids do not cover the additional charge for a home visit, in which case payment will remain the patient’s/guarantor’s responsibility.

It is never too late for speech therapy. People of all ages can benefit from it, whether it is for improving communication skills, recovering from a neurological injury, or just refining clarity. Speech therapists work with patients of all ages to address issues like swallowing ability, speech production, comprehension and use of language, social communication, or even cognition.

If you are thinking about it, there’s no age limit to making progress. If you would  like more information on how speech therapy can help you, do not hesitate to contact us.