Alternative medical aid

ShloshMalosh said:
fair enough.

but hows this deal? gimme a grand every month... if u knock your car i'll fix it, if you dont i keep the money
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Pretty much insurance yeah?

If you want the money don't take insurance and put it in your own "pocket" but be prepared to make up the differences depending on when it happens.
 
ShloshMalosh said:
fair enough.

but hows this deal? gimme a grand every month... if u knock your car i'll fix it, if you dont i keep the money
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It is because your car takes a lot more to fix than just the little grand you think does others a favour. You need 10 other people's money as well to fix your car.

Do you see the problem here?
 
ShloshMalosh said:
fair enough.

but hows this deal? gimme a grand every month... if u knock your car i'll fix it, if you dont i keep the money
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That's a business transaction - whether it's a good deal or not depends on a number of factors. It's not a scam though, unless you plan to renege on your commitment to pay.
 
Kosmik said:
Pretty much insurance yeah?

If you want the money don't take insurance and put it in your own "pocket" but be prepared to make up the differences depending on when it happens.
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i want my money ja... i earned it and i shouldnt be forced to give it to a medical aid or retirement fund for that matter. I can spend it in better ways

as far as consequences go... i dont live my life in fear of what ifs. prepare as best you can and get on with it. **** happens... and insurance claims often get denied for stupid reasons
 
Speedster said:
That's a business transaction - whether it's a good deal or not depends on a number of factors. It's not a scam though, unless you plan to renege on your commitment to pay.
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which happens more often than not from the insurers side.

Even worse with medical aids. Medical aids allow call center agents to practice medicine...
 
ShloshMalosh said:
which happens more often than not from the insurers side.

Even worse with medical aids. Medical aids allow call center agents to practice medicine...
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You're welcome to take that risk. I had a small motorbike incident in May. Medical cost is at about R150k already. If it was serious one could easily add a zero.
 
shaggy_beef_on_a_tricycle said:
It is because your car takes a lot more to fix than just the little grand you think does others a favour. You need 10 other people's money as well to fix your car.

Do you see the problem here?
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if i invested the grand every month and dont smash my car i get to pocket the profits.

why must i make an insurer rich who will deny my claim for any reason they see fit... only for my money to butt?
 
ShloshMalosh said:
if i invested the grand every month and dont smash my car i get to pocket the profits.

why must i make an insurer rich who will deny my claim for any reason they see fit... only for my money to butt?
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You are making that up. If you claim is rejected, 95% of the time it is because the error is on your side, not understanding the product, lying to your insurance.

You are also spending other people's money, not only your own.

I think the problem we have here is entitlement.
 
shaggy_beef_on_a_tricycle said:
I think the problem we have here is entitlement.
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Where is the real entitlement?

Fraudulent claims amongst medical practitioners is rife, even Medic clinic is on the act.

But because doctors are scarce, we treat them with kid gloves. Remember the Netcare organs for sale to rich buyers, the professors who performed the operations were let off with a slap on the wrist.


My own experience, years ago when my daughter was in the premature ward, was that the doctor made twice a day 15 minute rounds and look at the babies charts. She charged for that 2 x 1hour per baby at about R3000 i.e. R6000, there were about 10 to 15 babies, my daughter was 2 months in the ward.

I am sorry that was fraud, but is well known and accepted in the industry, with the end result is that premiums goes up and up to unsustainable levels.
 
TofuMofu said:
I'm also on this plan and it's been great.
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What's the dental cover like though..?

What are the defined set of benefits they mention..?
And what are the fixed co-payments and limits..?

Not been able to find the above details..
 
ShloshMalosh said:
insurance and medical aid are among the biggest scams

its basically gambling

just save the money for a rainy day and if u dont get sick... have a nice party with the savings or something
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Great idea until you get cancer and rake up R500k in 6 months without being able to work.

medical insurance is must.
 
rh1 said:
Where is the real entitlement?

Fraudulent claims amongst medical practitioners is rife, even Medic clinic is on the act.

But because doctors are scarce, we treat them with kid gloves. Remember the Netcare organs for sale to rich buyers, the professors who performed the operations were let off with a slap on the wrist.


My own experience, years ago when my daughter was in the premature ward, was that the doctor made twice a day 15 minute rounds and look at the babies charts. She charged for that 2 x 1hour per baby at about R3000 i.e. R6000, there were about 10 to 15 babies, my daughter was 2 months in the ward.

I am sorry that was fraud, but is well known and accepted in the industry, with the end result is that premiums goes up and up to unsustainable levels.
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You have the wrong end of the stick and don't understand the conversation. You are talking about exploitation. The person I was responding says all their claims gets rejected. Those are two different topics.
 
WAslayer said:
What's the dental cover like though..?

What are the defined set of benefits they mention..?
And what are the fixed co-payments and limits..?

Not been able to find the above details..
Click to expand...
Dental is basic checkup once a year per member.

Keep in mind, there is no MSA. For Classic Smart:

  1. You get hospital cover @ 200% MAR. In the network yes but make that call before hand so you know which hospitals are covered. NOTE in emergency, standard discovery, any hospital until stabilized and transferred.
  2. R60 per doctor visit, unlimited.
  3. OTC medication has a annual limit of about R750
  4. Acute perscribed medication has a annual limit of aprox R2.5k
  5. Chronic is covered same as chronic normal plans
  6. Usage of medexpress, clicks, dischem mandatory.
So you can pocket the MSA differance however you like and at least have basic out of hospital cover but the same as a hospital only plan, you will pay out of pocket, which is EXACTLY what a MSA is, just you have the annual balance available upfront.
 
Gtx Gaming said:
Move to smart classic, lets you see unlimted doctors visits for R60 a month.

Saved me tons money as also covers over the counter medicine.
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Kosmik said:
Dental is basic checkup once a year per member.

Keep in mind, there is no MSA. For Classic Smart:

  1. You get hospital cover @ 200% MAR. In the network yes but make that call before hand so you know which hospitals are covered. NOTE in emergency, standard discovery, any hospital until stabilized and transferred.
  2. R60 per doctor visit, unlimited.
  3. OTC medication has a annual limit of about R750
  4. Acute perscribed medication has a annual limit of aprox R2.5k
  5. Chronic is covered same as chronic normal plans
  6. Usage of medexpress, clicks, dischem mandatory.
So you can pocket the MSA differance however you like and at least have basic out of hospital cover but the same as a hospital only plan, you will pay out of pocket, which is EXACTLY what a MSA is, just you have the annual balance available upfront.
Click to expand...
  • OTC medication has a annual limit of about R750
Is this per member or per family?
 
I have the same problem with Discovery. In my case they want to increase the contribution by 19% but they are reducing the cover quite drastically. My biggest problem is their so-called 'network hospitals'
I want to be able to go to any hospital I want, as I have been able to do in the past. Now, if I want to go to a hospital outside their 'network', I have to pay an extra R12 000 upon admission. This is BS, not all hospitals have the right equipment and doctors affiliated to them.

Discovery has looked after me and my family very well over the years, but I think it is time for me to look elsewhere. I have asked my broker to look for another medical aid that will give me proper cover.
 
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