(Updated 10 October 2025)
Over the past few years, our clinic—and colleagues across SA—have pushed hard to make Transcranial Magnetic Stimulation (TMS) accessible. We’ve educated patients and doctors, brought more (expensive) devices into the country, opened services beyond the big metros, engaged state hospitals, and sat through countless meetings with medical aids. Progress exists. It’s also uneven.
The system pressures (and why access feels brutal)
- Medical aids under squeeze: NHI uncertainty, soft membership growth, and rising claims push schemes to be conservative.
- Private care stretched: We’re expected to deliver outcomes with fewer resources each year.
- Public sector overloaded: Governance problems and demand outstrip capacity.
Amid that noise sits one person: you, trying to get well—and your psychiatrist, trying to use what actually works.
Why TMS belongs on the table
TMS is a non-invasive, medication-free brain stimulation that targets mood circuits. For many people who haven’t responded to adequate trials of medication and therapy—or who can’t tolerate more drugs—TMS offers a real chance at response or remission. Side-effects are usually mild (scalp discomfort, transient headache). It’s guideline-supported locally and internationally.
The habit we need to break
Because schemes readily fund hospitalisation and medications, our system defaults to reflex admission and polypharmacy. Both can be necessary; neither is a cure-all. Repeated admissions and drug stacking don’t reliably produce remission, and side-effects accumulate. We should not keep doing the same things when a safer, evidence-based alternative exists.
Where funding stands (plainly)
- Discovery: first mover to recognise TMS with motivation on higher plans.
- Medscheme-administered options: acknowledge the evidence; approvals remain inconsistent.
- Momentum, CAMAF: case-by-case in defined circumstances.
- Trend: more schemes are at least reviewing psychiatrist motivations rather than rejecting outright.
What we’re doing (and won’t stop doing)
- Submitting standardised clinical dossiers and outcomes.
- Proposing risk-share pilots and clear selection criteria.
- Coordinating with colleagues to align protocols and safety screens.
- Arguing—patient by patient—that funding should follow evidence and function, not habit.
What moves policy fastest: member pressure
Schemes are member-led. When enough members request TMS with a proper clinical motivation, policies move. Many of the doors cracking open did so because patients asked—politely, persistently, and on record.
How you can help—today
1) Ask your psychiatrist for a motivation pack
It should include:
- Diagnosis and comorbidities
- Documented treatment resistance or intolerance (drugs, doses, durations, outcomes, side-effects; psychotherapy history).
- Proposed TMS protocol.
- Clinic and prescriber details (HPCSA-registered).
2) Submit a written request to your scheme (and get a written reply)
Subject: Funding authorisation request – TMS for treatment-resistant depression
Attach the motivation pack. Add a personal note on why you have struggled, and how you hope to benefit with TMS. Medical aids feel like huge monoliths, but they are run by people. Appeal to the person who will evaluate your case.
Ask for the specific policy clause used in the decision and criteria for approval if declined.
3) Appeal if declined—don’t stop at the first “no”
- Request the clinical rationale and the appeal pathway with timelines.
- Ask what additional information would change the decision.
- If internal appeals fail or stall, escalate to the Council for Medical Schemes.
4) Add your data point
If you improve with TMS, permit your de-identified outcomes to be shared with the scheme. Real-world SA results shorten the distance between “case-by-case” and “covered benefit.”
