Medical Aid!

medicnick83

medicnick83

Paramedic
Joined
Aug 23, 2006
Messages
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Location
CBD, Cape Town
Hi all,

I think I've posted about this before and I am starting a new topic on purpose!
We all know about the issue that recently happened with "Corrie Sanders"

Please, contact your medical aid, make sure it's still active, make sure of what your medical aid covers, make sure you family each have medical aid cards and understand how it works and what to do if it is needed (what hospitals to goto, what hospitals NOT to goto!)

I am pleading with you guys!
I see dramas all the time with medical aids - people think the medical aid supports X but it doesn't, it actually supports Y and it's too late when you need it.

Please! check, make sure and educate yourself about it - so when the worst comes to pass, you are covered!

I'm almost tempted to ask rpm to sticky this as it is insanely important!!!
 
Ya, I couldn't agree more! I once heard a story of someone that had a car accident, and walked away without injury. However, after a few weeks, he started having terrible headaches, and was told by his doctor that he needed an MRI. Unfortuantely, he was not covered by his medical aid :(.
So, before I signed up to my hospital plan, I asked my broker, "If I need an MRI without being admitted to hospital, will they cover me". He replied, "yes". A few months later (as fate would have it), I needed to get an MRI, and was told by Discovery that MRIs are only covered if you have a savings plan in addition to the hospital plan. So I had to pay R10k out of pocket.

So please please be careful and spend some time checking and double checking all the facts.
 
After the Sanders incident I was thinking what would happen if you get robbed and shot, and then not being in a position to speak how do you relay to the paramedics you have a medical aid? Even premium coverage will be of no help if it can't be communicated.
 
zeb said:
After the Sanders incident I was thinking what would happen if you get robbed and shot, and then not being in a position to speak how do you relay to the paramedics you have a medical aid? Even premium coverage will be of no help if it can't be communicated.
Click to expand...

Stickers on car, card in pocket, ICE on phone.
 
zeb said:
After the Sanders incident I was thinking what would happen if you get robbed and shot, and then not being in a position to speak how do you relay to the paramedics you have a medical aid? Even premium coverage will be of no help if it can't be communicated.
Click to expand...

Was wondering the same thing, if you're mugged, injured and unable to communicate, it means you're screwed! Medical Aid or Not your unconscious ass will lay in a public hospital till you kick it...
 
Kosmik said:
Maybe medical aids should bring back the medic alert bracelets.
Click to expand...

Well I've got dog tags with my info on it, the question is if paramedics will actually pay attention to it
 
I have a Liberty Life Hospital Plan, plus gap cover. I had a wrist op and Liberty covered everything except the physio who were not really necessary. Even an MRI scan which cost R 10k. I found by reading the gap cover policy carefully that certain dental procedures were covered and got them to pay R 9500 towards a R 13000 implant.

While Liberty Life are excellent with their claims procedure, the guys running the gap cover seem to be duckers and divers and tell you "no" without even finding out the proper answer.
 
chrisc4290 said:
I have a Liberty Life Hospital Plan, plus gap cover. I had a wrist op and Liberty covered everything except the physio who were not really necessary. Even an MRI scan which cost R 10k. I found by reading the gap cover policy carefully that certain dental procedures were covered and got them to pay R 9500 towards a R 13000 implant.

While Liberty Life are excellent with their claims procedure, the guys running the gap cover seem to be duckers and divers and tell you "no" without even finding out the proper answer.
Click to expand...

I'm with Discovery. I have had to make 2 claims from GAP Cover during the last year and half...both for ops om my kids (grommets). Absolutely no hassles and very quick payment.
 
If you have medical aid already, what is gap cover actually for? Does it pay out when the specialist charges over and above medical aid rates?
 
chrisc4290 said:
I have a Liberty Life Hospital Plan, plus gap cover. I had a wrist op and Liberty covered everything except the physio who were not really necessary. Even an MRI scan which cost R 10k. I found by reading the gap cover policy carefully that certain dental procedures were covered and got them to pay R 9500 towards a R 13000 implant.

While Liberty Life are excellent with their claims procedure, the guys running the gap cover seem to be duckers and divers and tell you "no" without even finding out the proper answer.
Click to expand...

Depends on who provides your GAP. Complimed have been very good to my family and I, otherwise I'd have to had fork out 150k out of my own pocket.
 
Kosmik said:
Depends on who provides your GAP. Complimed have been very good to my family and I, otherwise I'd have to had fork out 150k out of my own pocket.
Click to expand...

I briefly looked through complimed's FAQ....you have to pay the shortfall yourself and claim the reimbursement? So at some point the money is still out of your own pocket?

I'm looking for a gap cover that has no exclusions for pre-existing conditions, and no waiting period. Is that impossible? Also, how much should I look at paying for gap cover? My med aid is only R1500 a month for two of us..I can't be spending close to that for gap cover.
 
Our government has been planning to introduce an amendment bill to abolish gap and top up cover, which may force medical aids to upgrade their products. This ultimately will result in additional increase in premiums.

What the government should be doing is regulating the fees charged by healthcare professionals. There is currently no law preventing them from charging a variance in rates from one patient to the next, and charging any fee. And of course people often don’t often negotiate with the practitioner to charge medical aid rates, even for planned procedures.

Ironically, a large number of healthcare professionals have emigrated to other countries out of concern over the implementation of NHI and the implications thereof, however have contributed to inflated medical aid premiums.

Medical aids introducing extensive hospital, GP and Specialist networks seem to be on the right track. Time will tell if it will improve the premium versus claims ratio.
 
Ms_S said:
I briefly looked through complimed's FAQ....you have to pay the shortfall yourself and claim the reimbursement? So at some point the money is still out of your own pocket?

I'm looking for a gap cover that has no exclusions for pre-existing conditions, and no waiting period. Is that impossible? Also, how much should I look at paying for gap cover? My med aid is only R1500 a month for two of us..I can't be spending close to that for gap cover.
Click to expand...

Depends. If you are able to, you can rotate the funds on credit ie: swipe a credit card with 55 day , gap pays out within 21 days so you are re-imbursed. Also a lot of medical practitioners understand that GAP can take a month which is normally well within their billing cycle of 30 days and are willing to wait for a definate payout than no payout. Mine was a bit of an extreme case but the specialist in question was comfortable with the fact I had GAP.

As to the killing off of GAP, it's going to be a huge problem. I cannot stomach the thought of what I went through with my son in a public institution. We had nurses with other private facilities who came through as well and they say we were lucky in where we were even being private.
 
My gap cover was arranged via the Liberty Life broker who managed the hospital plan. He got it sorted immediately, no waiting. When I had my implant done, GAP said there was no such code. We went through the backwards and forwards for 3 weeks until I got a copy of their codes list. It was on page 7. As soon as I pointed this out, they paid.

Also, IMO, National Health will never work in SA, the tax base is too small. I suspect it is an electioneering ploy.
 
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