Really bad news for medical aid members in South Africa

spiff said:
yeah his medical aid paid - but still - the costs are down right shocking to say the least. :mad:
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Surgeon's fees was R70K, if I am not mistaken. Not too shabby for 2-3 hours of surgery time. I should have studied I suppose. LOL
 
hellfire said:
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.
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They are an absolute joke because you don't even get the interest on them.
The current solution I have found is:
1) Get a good hospital plan that covers actual diseases you cannot avoid. You don't want one that covers additional things like antenatal stuff for example.
2) Get really good gap cover.
3) Look at the price Discovery charges for an equivalent plan with a MSA, and put the difference into a Bank Zero bank account and earn the interest. if you are doing it for a family, it builds up very quickly.

My Profmed plan didn't cover any of the antenatal consultations or labs for konfabling #3. I just paid out of pocket for all of them. Fun thing is that the difference in premiums between coastal saver and the plan completely paid for all the antenatal stuff and I still contributed far more into my "MSA" than Discovery ever did.

What I really hate about the current system is the fact that despite PMB conditions being law, the medical aids don't cover them fully, as there is a risk specialists charge more. Which defeats the point of the condition being a minimum benefit. Anaesthetists are the primary guilty party here as you don't get to pick them.
 
konfab said:
2) Get really good gap cover.
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It strikes me as it being absurd, given how much I'm already paying, that there could be a gap that needs to be covered.
 
bwana said:
It strikes me as it being absurd, given how much I'm already paying, that there could be a gap that needs to be covered.
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It is ridiculous, but it is the market addressing a problem the government caused.
 
Sideshow Bob said:
My SO had wrist surgery done last year. Cost was R120K if I recall. All paid for by scheme. Hospitalization expenses are scary really.
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My cousin had a hectic motorbike accident September last year - cost of just the hospital bills (6 surgeries so far and hopefully no more) > R1.1million! Granted, without the surgeries, he wouldn't be able to walk or hold anything ever again so they saved him.

He was completely covered by the PMB but there are so many extra additional costs out of hospital that he is still out of pocket >R100k and he is on a very good Discovery plan with a medical savings account. South Africa still has incredible private healthcare but unfortunately it comes at a price!
 
Check out the doctors/specialist parking bays.
That's why they charge an arm and a leg
 
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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:oops: My shoulder surgery was cheaper at R60kish

Guess a wrist is much more complicated but damn.... R 120k/R140k
 
DreamKing said:
I cut my family medical aid since last year.
I already have saved R100k+ up to now. :) and my medical expense is still "nothing". :p

thank God. :)
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You need to hope you have no big medical expenses anytime in the next 10 or so years if you're only saving R100k a year.
 
It's leaving families like mine in a terrible situation. Thing is medical aid is an insurance product. You never know if you are gonna be the unlucky family or not. We were all healthy and paid for medical aid for years hardly using it. Then my daughter came along and she was just the unlucky one. She has a genetic dread disease and while she can live a happy and full life with the right treatment it costs about R40K in medication a month. Currently all paid but only on classic comprehensive or above. So my family medical aid costs me around 18K pm. If I had been off medical aid and tried to join after the diagnosis the exclusion period would have been years. So I still advise staying on the lowest level you can manage, even if its just a hospital plan. You can upgrade later from a low option. Getting on from nothing though after you get cancer or something bad is a nightmare.

If the healthy all abandon it the whole system will collapse.

Imagine for instance something similar like fire insurance. We all pay a small part of our house insurance towards the risk of fire. For 99.9% of people that is money lost as most people never have their house burn down. Fortunately because its a low risk its also a small percentage of the insurance bill compared to medical aid but if everyone just said no, I don't believe in fire insurance, odds are so low I will just remove that portion of my insurance bill, then eventually fire insurance would collapse and people who are unlucky and have their house burn down lose it all.

You never know when bad news can arrive. Never thought it would happen to us until it did. So be very careful around cancelling that. And remember while daily benefits run out PMB benefits (chronic) can't by law. So if you do get something big like cancer, etc being on medical aid could be worth millions at that point.
 
The medical industry is becoming like lawyers and estate agents.

Our daughter is sick - so we're at the doc on Sunday, since we're going to a malaria area next month, we asked about a prescription while there.

No, make a separate appointment for our daughter for that, and then a separate appointment for every other person going. So they wanted over 2k from us just for malaria prescriptions.
 
Blu82 said:
Discovery is not a Medical Aid Scheme is the simple answer here since they circumvent "the you are not allowed to make any money" rule by paying a 'licensing fee" to the parent Discovery company.
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Discovery medical aid scheme is non profit, Discovery health administrator on the other hand is all about the profit and Discovery medical scheme dont pay a 'licensing' fee, they pay a standard negotiated administration fee per beneficiary, so its in the best interest of the administrator to build a health costing model that benefits their administration fee, hence they have Vitality as a tool to monitor member lifestyle, they negotiate preferred rates with hospitals, doctors, pharmacies etc. Discovery's we pay 200% of medical rates is a marketing tool, 200% of discovery rate is 100% of NHRPL rate which every medical scheme in South Africa has to pay by law.

Im speaking from 23 years' experience in the medical aid sector and no i dont work for Discovery and hopefully will never have to.
 
Pax said:
How long before pensioners also no longer can afford their medical aid, and then more and more employed to follow. A simple hospital plan for 2 is already over R6k per month.

Is it solely the medical aid's fault or is it the specialist doctors charging R1900 to R2500 for a 15 minute consultation, or R14k for a procedure whilst the MA tarrif is R6k?(based on recent experience)
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Unfortunately doctors are not regulated, they can charge up to 400% of medical aid rates and get away with it. Always find a doctor who charges medical aid rates, just because some douchebag doctor charges an arm and leg, doesnt mean they are the best, it just means they are greedy. There are still some old school docs who genuinely want to make a difference by helping people but they are few and far between.
 
xrapidx said:
The medical industry is becoming like lawyers and estate agents.

Our daughter is sick - so we're at the doc on Sunday, since we're going to a malaria area next month, we asked about a prescription while there.

No, make a separate appointment for our daughter for that, and then a separate appointment for every other person going. So they wanted over 2k from us just for malaria prescriptions.
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That is a terrible doctor. Find a better one.
 
Cius said:
That is a terrible doctor. Find a better one.
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Unfortunately we had no choice, Sunday at a Medicross - our usual place is Intercare which was fully booked.

It gets worse, by Monday daughter was still sick, dehydrated, and needed to be hospitalized, this doctor knew that and told us to call so she could arrange it, we had to call three times from the morning and she was constantly busy, at this stage:
* she hadn't eaten since Thursday, everything she tries comes straight back up - including water.
* she hadn't been to the bathroom since Thursday - her stomach was rock hard - and she had severe cramps
* she had headaches and a fever - the pain was bad enough that she couldn't sleep.

Eventually the doc calls back in the afternoon and tells us she doesn't know we must decide whats wrong and if she needs to be admitted and to call her back in 1 hour because she clocks off at 3pm. I actually asked the doctor if she's not constipated because of the cramps and hard stomach, and not going to the bathroom for about 5 days, doc says it impossible she hasnt eaten enough.

Tuesday morning we took her to the emergency room - they didn't wait - admitted her immediately - xrays showed she was severely backup up - straight on to a drip with tons of medicine. Also diagnosed with swine flu. Only just been discharged after a two days stay.

Guaranteed we're still going to get invoiced by Medicross for about 1k for Sundays visit.
 
xrapidx said:
Unfortunately we had no choice, Sunday at a Medicross - our usual place is Intercare which was fully booked.

It gets worse, by Monday daughter was still sick, dehydrated, and needed to be hospitalized, this doctor knew that and told us to call so she could arrange it, we had to call three times from the morning and she was constantly busy, at this stage:
* she hadn't eaten since Thursday, everything she tries comes straight back up - including water.
* she hadn't been to the bathroom since Thursday - her stomach was rock hard - and she had severe cramps
* she had headaches and a fever - the pain was bad enough that she couldn't sleep.

Eventually the doc calls back in the afternoon and tells us she doesn't know we must decide whats wrong and if she needs to be admitted and to call her back in 1 hour because she clocks off at 3pm. I actually asked the doctor if she's not constipated because of the cramps and hard stomach, and not going to the bathroom for about 5 days, doc says it impossible she hasnt eaten enough.

Tuesday morning we took her to the emergency room - they didn't wait - admitted her immediately - xrays showed she was severely backup up - straight on to a drip with tons of medicine. Also diagnosed with swine flu. Only just been discharged after a two days stay.

Guaranteed we're still going to get invoiced by Medicross for about 1k for Sundays visit.
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OK. Get that. My doctors are at the NHC center in Honeydew. Sunday there will be one or two doctors working but it's unlikely to be your preferred doc. Had that last Sunday but fortunately the doc I took my son to was decent. Have had some dud experiences as well. And they do charge extra for Sunday appointments so I had to pay in R350 on top of what the medical aid paid.
 
Sideshow Bob said:
Indeed. We are sorry that your MSA is finished for this year due to one dental crown but hey, our CEO's need bonus and we need swanky offices in swanky areas.
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Even more annoying is the sub-limits. I needed two in one year so then you get told that even though you have R20k in your MSA, you've reached the sub-limit for dental devices so pay the second one out of pocket.
 
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