Really bad news for medical aid members in South Africa

Sideshow Bob said:
Problem is even after paying this much, MSA account still runs out at times.
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MSA accounts for day-to-day are not when you rely on medical aids. It's when something goes wrong and you need massive medical intervention that medical aid (insurance) comes into its own.
 
If it's too costly just go for the cheapest possible plan, and save your money to pay cash whenever necessary. That's what I've done for the last 20 years.
 
spiff said:
gee wonder why?



So a friend of mine step daughter recently broke her wrist - cost for repairing her wrist R140k!!! :mad:

GTFOH!!:mad:
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It doesn't get magically cheaper without medical aid. you either pay up or go to a state hospital.
 
From the article:
Njilo also called for a rethink of the healthcare model itself, with a greater focus on prevention and early diagnosis instead of expensive hospital-based treatment.
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Completely agree with this - it's in both the person and the insurer's best interest for this to happen. That's why Discovery has so many Vitality hoops to jump through, Momentum Multiply etc.
 
dualmeister said:
Mediclinic literally made us pay R150K at 08.15PM before they would admit my dad to ICU last month.
Make sure you at least have a hospital plan people.
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If you can afford it, it's very stupid not to have it.
By "can afford it", I mean it should be a priority over many other household expenses.

EDIT: not calling you / your dad stupid
 
hellfire said:
From the article:


Completely agree with this - it's in both the person and the insurer's best interest for this to happen. That's why Discovery has so many Vitality hoops to jump through, Momentum Multiply etc.
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I actually disagree. Ask anyone who has tried to navigate preventative care. The admission guidelines are ridiculously high and when you finally meet them, you are going through the full costly hospital route.
 
Kosmik said:
I actually disagree. Ask anyone who has tried to navigate preventative care. The admission guidelines are ridiculously high and when you finally meet them, you are going through the full costly hospital route.
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Perhaps we're talking past each other. I don't mean scopes and other in-hospital procedures. If that's what you need, then it's the normal route with medical aid claims, unfortunately.

Getting tested and monitored annually isn't very strenuous.
For example, blood pressure, cholesterol, blood sugar - very cheap to check.
Pap smears, prostate tests, mammograms - similar.
If you get symptoms of something, don't delay getting it looked at before it's a crisis.
Catching something early is almost always cheaper and has better prognosis than catching it later.
 
hellfire said:
Works for day to day expenses, doesn't easily work for a R100k procedure. Especially if you get more than one in a short period of time.
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Hospital plan which is the cheapest should cover it. Like Discovery Essential Smart (I'm on this one).

I was admitted in 2021 at Mediclinic for 3 days (just some dizziness). They did a bunch of tests and scans, saw a couple of different Drs. The bill was about R25k. I only paid about R500 for meds from the pharmacy when leaving. Discovery paid the rest.
 
hellfire said:
Perhaps we're talking past each other. I don't mean scopes and other in-hospital procedures. If that's what you need, then it's the normal route with medical aid claims, unfortunately.

Getting tested and monitored annually isn't very strenuous.
For example, blood pressure, cholesterol, blood sugar - very cheap to check.
Pap smears, prostate tests, mammograms - similar.
If you get symptoms of something, don't delay getting it looked at before it's a crisis.
Catching something early is almost always cheaper and has better prognosis than catching it later.
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Only problem (from the insurers point of view) is you're now opening it up to very speculative things, and that is an avenue that Drs will abuse the hell out of.

Yes all the preventative tests are standard and known costs, but when they "find" something it can get very speculative.
 
hellfire said:
Perhaps we're talking past each other. I don't mean scopes and other in-hospital procedures. If that's what you need, then it's the normal route with medical aid claims, unfortunately.

Getting tested and monitored annually isn't very strenuous.
For example, blood pressure, cholesterol, blood sugar - very cheap to check.
Pap smears, prostate tests, mammograms - similar.
If you get symptoms of something, don't delay getting it looked at before it's a crisis.
Catching something early is almost always cheaper and has better prognosis than catching it later.
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No, we are on the same page but lets say good examples.

My family is notoriously diabetic, which I have managed to avoid with good health, however we have a strong pre-disposition to it as well as heart issues. For that, I get tested regularly etc. However, as per Discovery:

1. They are not concerned about the pre-disposition even though I used to have very high insulin resistance levels ( 50+ ) and my sugar was still at decent levels so my doc prescribed some preventatives for both as well as hypertension ( which I am registered ) but the medical aid will ONLY cover stictly the single hypertension.
2. My wife was diagnosed with high blood pressure last year ( 160+ ). We got her on chronic as well but Discovery refused to pay for a monitoring device out of the health monitoring benefit ( which most folk arent aware but does cover things like bp machines etc and is on most plans ). So both her and I are hypertensive, she a lot worse although controlled now and the medical aid will only pay if she sustains a bp of 160 or higher for longer than 3 months. Thats a pretty insane metric and not in the patients best interest at all.

The stupidity is that its not like the meds wont be used by the patient or the machine, its not going to be sold but they would rather cover for much more expensive in hospital treatment or a complication PMB than proper preventative care.
 
Forum Reader said:
Hospital plan which is the cheapest should cover it. Like Discovery Essential Smart (I'm on this one).

I was admitted in 2021 at Mediclinic for 3 days (just some dizziness). They did a bunch of tests and scans, saw a couple of different Drs. The bill was about R25k. I only paid about R500 for meds from the pharmacy when leaving. Discovery paid the rest.
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Folks also ignore the income banded plans. For folks who don't work or can't afford higher, those are worth a look.

I used to be on Keycare for years and it covered everything. Now days its a bit differant but if your income is low, well worth checking out.
 
Deandbn said:
Exactly 25 specific prescribed minimum benefits.
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No, don't confuse PMB with Chronic. 26 Chronic condition which are also PMB's but there is a much larger basket of pmbs they love to hide.

Prescribed Minimum Benefits | Council for Medical Schemes

Prescribed Minimum Benefits (PMBs) are defined benefits to ensure that all medical scheme members have access to minimum health services.
www.medicalschemes.co.za www.medicalschemes.co.za

PMBs are a feature of the Medical Schemes Act, in terms of which medical schemes have to cover the costs related to the diagnosis, treatment and care of:
When deciding whether a condition is a PMB, the doctor should only look at the symptoms and not at any other factors, such as how the injury or condition was contracted. This approach is called diagnosis-based. Once the diagnosis has been made, the appropriate treatment and care is decided upon as well as where the patient should receive the treatment (at a hospital, as an outpatient or at a doctor’s rooms).
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spiff said:
gee wonder why?

So a friend of mine step daughter recently broke her wrist - cost for repairing her wrist R140k!!! :mad:

GTFOH!!:mad:
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My SO had wrist surgery done last year. Cost was R120K if I recall. All paid for by scheme. Hospitalization expenses are scary really.
 
Kosmik said:
No, don't confuse PMB with Chronic. 26 Chronic condition which are also PMB's but there is a much larger basket of pmbs they love to hide.

Prescribed Minimum Benefits | Council for Medical Schemes

Prescribed Minimum Benefits (PMBs) are defined benefits to ensure that all medical scheme members have access to minimum health services.
www.medicalschemes.co.za www.medicalschemes.co.za
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Yeah have had to fight with Med Aids before about the PMB thing.. they love hiding it or just being "ignorant" when it suits them.
 
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