Medical Aid Advice

The_Ogre said:
Or, you know, just put the money in your bond and pay cash for your medical visits.

The only regular expense I have is my glasses every two years. So that's R5k every two years instead of monthly.

My GP charges R495 per visit so I gladly pay that when one of my kids have the sniffles - which is rarely.

Personally, the only predisposition I have is my grandfather who had prostate cancer. I'm willing to take my chances.

Don't get me wrong, if you have a history of diseases in your familial lineage, get medical aid. However, I struggle to get the notion of people forking out R10k monthly when they have no heredary defects.

Edit: hereditary. Stupid autocorrect
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That’s all very well but just wait until it’s a bad accident or some other weird infection or burst appendix. The hell I have seen and heard of at government hospitals means I don’t take that chance, minimum hospital plan. There are some decent government hospitals but in an emergency you’ll get sent to whichever is closest and that may be a hell hole.
 
Tomtomtom said:
Good luck with that. They'll work their way out of PMB coverage like Harry Houdini.

The thing nobody tells you is that whatever coverage they can work themselves out of, the gap cover doesn't help you with either.

It's true you will get inpatient hospital costs covered but those are f***cking made up anyway.

With a hospital plan, you better be prepared to negotiate hard.
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Worked fine for my two PMBs.
 
This is a difficult one. Medical Aid in South Africa is basically another tax. You need to at least have a hospital plan. You might never have to go to a hospital, and you might never get the money you spent back, but the day you need a hospital you would want to get the carer you need. Even with medical aid, you might still need to cover that in cash unless it is a life threatening emergency or it will be covered by a hospital emergency, aka getting admitted to hospital. It might also be covered by PMB's. However the treatment might not be what you want or take longer than what your specialist would have provided if you pay out of your own pocket.

Can also look at GAP cover. But check what they will cover.

Once you have an existing condition and only then join a medical aid, you will need to wait 12 months before you are covered.

So I would say your OP has nothing to do with if it is worth getting a medical aid or not.

If at some point you need a hospital in a life treatining situation, and your public hospital is not a solution, then you would want private hospital cover.

Okay, I'll stop blabbering. Get a hospital plan.
 
airborne said:
That’s all very well but just wait until it’s a bad accident or some other weird infection or burst appendix. The hell I have seen and heard of at government hospitals means I don’t take that chance, minimum hospital plan. There are some decent government hospitals but in an emergency you’ll get sent to whichever is closest and that may be a hell hole.
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In the event of an emergency, by virtue of protocol, the ambulance crew will take you to the nearest hospital. Public or private.

You will only be moved to a public hospital once you confirm you do not have medical cover.

Even then, you have the option to pay for treatment as a private patient, as opposed to a medical aid patient.

My ex worked as a medical aid account manager at a company that bills medical aids on behalf of doctors.

Some specialists bill at 400% because there's no oversight. I'd rather pay cash than fund that kind of extortion.
 
The_Ogre said:
Or, you know, just put the money in your bond and pay cash for your medical visits.

The only regular expense I have is my glasses every two years. So that's R5k every two years instead of monthly.

My GP charges R495 per visit so I gladly pay that when one of my kids have the sniffles - which is rarely.

Personally, the only predisposition I have is my grandfather who had prostate cancer. I'm willing to take my chances.

Don't get me wrong, if you have a history of diseases in your familial lineage, get medical aid. However, I struggle to get the notion of people forking out R10k monthly when they have no heredary defects.

Edit: hereditary. Stupid autocorrect
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until something unexpected happens and you or your family need emergency treatment and you're left to try survive the public health system
 
Tomtomtom said:
You know it is actually possible to tell the hospitals to go f*** themselves.

They do after all just make up the numbers. It's got nothing to do with the actual cost.

They charge everyone 5 billion rand in the expectation that some people's medical aids will pay 50k and others will pay zero. In the end it works out just fine for them.
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good luck with that, pal.
A private hospital won't even accept you if you don't have medical aid or a massive prepayment.
So it's actually them telling you to go f*** yourself
 
The_Ogre said:
In the event of an emergency, by virtue of protocol, the ambulance crew will take you to the nearest hospital. Public or private.

You will only be moved to a public hospital once you confirm you do not have medical cover.

Even then, you have the option to pay for treatment as a private patient, as opposed to a medical aid patient.

My ex worked as a medical aid account manager at a company that bills medical aids on behalf of doctors.

Some specialists bill at 400% because there's no oversight. I'd rather pay cash than fund that kind of extortion.
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The ambulance crew will not take you to a private hospital because it's closer. That's a common misconception.
Unless they can ascertain that you are indeed covered, they will take you to public.
Source: I'm an ambulance medic
 
I cant offer an overall solution here, but as they say:

"You pay for what you get"

These schemers have their ducks in a row and I wouldn't be surprised the Competition Commission knocks/breaks down their doors seizing documents and data.

I would think that you pick the most simple plan (above a simple hospital cover) and just under budget and a large GAP cover policy offering good cover, say around R2300, it doesnt sound like you need a lot of cover, or go for 200% cover and a medium GAP cover, I would pick the latter. Do not look at a savings pocket at all, you can cover the expenses. You are still young you should get immediate cover You should be fine, just be careful of network hospitals and co-pay. Discovery and Bestmed are well known for been lenient.
 
Sensorei said:
You never need medical aid until the day you really need it.

My bright spark cousin didn't think it was necessary, picked up an antibiotic resistant bacteria, and now they're in over R500K debt after they had a long stint in hospital. You need to have at least a decent hospital plan.
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Is he OK? Asking because my brother in law had antibiotic resistant bacteria and had to have his leg amputated.
 
maumau said:
Is he OK? Asking because my brother in law had antibiotic resistant bacteria and had to have his leg amputated.
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Sorry to hear that. She is fine now, but it was touch and go for a while. Lucky to be alive.

What's mind boggling is that she is a nurse, so she should know better. But her idiot husband convinced her that medical aid wasn't worth the money.
 
ICU can go up to a 100k a day. The high tier drugs can cost R700 a tablet. Some cancer drugs are in the 10s of thousands. MRI is over 10k. Theater time is roughly R2.50 a minute.

You getting the picture ?

Drug resistant TB is so expensive to treat that only the government pays for it. One XDR patient treatment can cost up to a R120k for the drugs alone a month and the treatment course goes for 18 months
 
The_Ogre said:
In the event of an emergency, by virtue of protocol, the ambulance crew will take you to the nearest hospital. Public or private.

You will only be moved to a public hospital once you confirm you do not have medical cover.

Even then, you have the option to pay for treatment as a private patient, as opposed to a medical aid patient.

My ex worked as a medical aid account manager at a company that bills medical aids on behalf of doctors.

Some specialists bill at 400% because there's no oversight. I'd rather pay cash than fund that kind of extortion.
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Dude you are living in lala land, money talks and when the specialist says 400% rates or gtfo you either pay or gtfo.
In any case the specialists fees are the least of your worries it’s the theatre costs, ICU daily rates, medicine rates, prosthetics rates etc etc.

The bottom line is a serious accident or illness can properly bankrupt a person without medical aid. Just like not having car insurance can do the same and what idiot doesn’t have car insurance, why insure your car and not your body. But that’s assuming you have car insurance, maybe you truly are a balls to the wall kind of guy and I need to back the fk off..
 
A good medical aid is like a parachute. It's good to have it but not need it, but disastrous when you need it but do not have it.
 
airborne said:
Dude you are living in lala land, money talks and when the specialist says 400% rates or gtfo you either pay or gtfo.
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Except they operate first and only tell you the price once you're fixed up.

Do you know any other businesses that do that? So there's a bit of quid pro quo. They might bill you 400% but they don't expect you to pay it.

airborne said:
The bottom line is a serious accident or illness can properly bankrupt a person without medical aid.
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This is true in the US maybe but I don't hear lots of stories of locals getting bankrupted by the medical system. Maybe because public is still an option even if it's a last resort.
 
hellfire said:
good luck with that, pal.
A private hospital won't even accept you if you don't have medical aid or a massive prepayment.
So it's actually them telling you to go f*** yourself
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Then where does this story come from?

Sensorei said:
You never need medical aid until the day you really need it.

My bright spark cousin didn't think it was necessary, picked up an antibiotic resistant bacteria, and now they're in over R500K debt after they had a long stint in hospital. You need to have at least a decent hospital plan.
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Did the hospital forget to refuse their admission?

Bottom line is the medical industry spends 80% of its time chasing debtors but the whole business model is based on cross-subsidy from the over-insured.

Gap cover is a great case in point. Just mention you don't have any and suddenly you've got a 50% discount.
 
The_Ogre said:
Tell the doc to refer you to Tygerberg or Karl Bremer.

On the form, just state you earn R2 000 per month.

Make sure you go there with your kakkest clothes and bribe a hobo for their clothes if you have to.
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My wife has been using the Western Cape Health Service since I was unemployed, once I started working again, her condition was excluded from Medical Aid. The Health Department finally gave the go ahead for the operation she needs, but I am not sure as the waiting period on the exclusion on the medical aid is nearly up. But she is in immense pain, so its for me to say rather wait as she is suffering at the moment.
 
airborne said:
The bottom line is a serious accident or illness can properly bankrupt a person without medical aid. Just like not having car insurance can do the same and what idiot doesn’t have car insurance, why insure your car and not your body. But that’s assuming you have car insurance, maybe you truly are a balls to the wall kind of guy and I need to back the fk off..
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I don't have car insurance...because I don't have a car :)
 
Tomtomtom said:
Except they operate first and only tell you the price once you're fixed up.

Do you know any other businesses that do that? So there's a bit of quid pro quo. They might bill you 400% but they don't expect you to pay it.



This is true in the US maybe but I don't hear lots of stories of locals getting bankrupted by the medical system. Maybe because public is still an option even if it's a last resort.
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You have been posting useless sht all over this thread.

Of course they can’t tell you the bill up front because they don’t know what compilations they may encounter during the operation. What’s the alternative, mid operation they give up because they have reached the the monetary amount initially quoted and then sorry sir no more morphine, there’s nothing left in the budget, hang on tight, here’s a shoe to bite down on..

I’ve heard of many stories of people being bankrupted by medical bills in South Africa, it’s not hard to understand or believe how that can happen very easily. Public hospitals may be a fall back of sorts but that’s only if there is a decent one near you and even then if you need care asap or to see a certain specialist private is the only other option.
 
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