Medical Aid - watchout

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Fuma

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So me, son, and wife are with MediHelp medical aid. My son was admitted to the hospital around May for bronchitis for 5 days.
Two days ago I received a letter of demand from debt collector about R950 I owe the hospital. So I went to the hospital to understand what's happening.

Luckily the lady was very helpful and she told me they got new changes a month or so ago from MediHelp about new changes about certain conditions that you as a patient have to co-pay when you are admitted.
So I went to MediHelp (not too far from the hospital fortunately) to get to the bottom of this, and initially they told me I got wrong info from the hospital. I insisted and they had to check their systems to verify the info and it appeared it was indeed true that there has been some changes with certain conditions. So these new changes only came to effect AFTER my son had already been to the hospital. So they said are going to pay.
To think I was almost going to pay that amount. Eish. Summons issued in the Magistarte and getting sent to the credit bureau.

I'm not sure if they sent any notification/communication to me about these changes, but then they only applied after my son was in hospital.

So from now on I'll check my post, make calls to the scheme in case some things have changes/added/whatever. Haibo.
 
Find ou what these changes are all about. If it is something like anything over 100% medical aid rates then get a GAP cover which is very cheap, I'd say about R100-R150p.m for the whole family and that covers you up to 400% medical aid rates, prices will vary depending on which comapny you use. It's really worth it as specialist fees and etc could be costly.

If that's not the case then post what do they charge co-payments for and at what rates, also what plan are you on, I'd like to compare it for you and give you an opinion if you like as I'm in this industry.
 
I still don't get why the f*** you need to get extra cover to cover what your medical aid doesn't cover. Pure BS IMO.

Wife's cousin gave birth recently and used the same gynae she used throughout her pregnancy. Problemis, neither the gynae or the medical aid told her the gynae is no longer on their "preferred" list, so she had to pay in a couple of odd-thousand where they thought they were fully covered.
 
The problem is that doctors will charge as much as possible. Before when doctors found out that you were on say 300% scheme they charged that amounth which end of the day would increase the costs and therefore medical aid membership becomes even more expensive. So the medical aid now have gap cover which the doctors don't know about and will bill you for the extra costs, but when they know it's you they might charge say 200% instead of say 300% if they knew you had a higher cover.
 
So I went to the hospital to ask if MediHelp paid and they didn't. So I went back to MediHelp and I found another person and I was told it could take weeks or months until they have paid the Hospital since it was not a normal claim - it was a hospital claim.

So I decided to pay the Hospital and deal with MediHelp later to save myself from being listed. I am starting a new job next month and I thought I could carry it over to my new employer, but I'm having second thoughts.

I will look at the GAP cover which I didn't take on my previous medical aids.
 
Quick question, did you phone for pre-authorization for hospitalisation? If you did, why did they not inform you then?
 
EnchanterG said:
Quick question, did you phone for pre-authorization for hospitalisation? If you did, why did they not inform you then?
Click to expand...
The amendments only happened after my son was admitted and discharged form the hospital.
 
Fuma said:
The amendments only happened after my son was admitted and discharged form the hospital.
Click to expand...

As far as I know, when they give you an authorisation number they also tell you what they will & wont pay for, irrespective of any amendments that may occur during the hospital stay.

My hospital bill was settled in full... 7 days after I was discharged.
I am on medihelp necesse.
 
Had similar fun.

Went to Eugene Marais (as a 2n'd opinion) for my collarbone I broke in an accident (they put a plat on it after it showed no signs of healing about 2 months after the accident).
Anyway long story short, I resigned my job shortly after that, cancelled the medical aid (as it was a company specific one) and went on a 1 year walk about.
Came back and stayed at my parents (was working for my dad at the time).

Sheriff of the court pitched at my house and wanted to take my stuff, told him I have 2 boa constrictors and a Nokia 5110 and asked who it was. Ended up being Eugene Marais accounts dept that screwed up.

Called the Medical aid, got proof they paid the account, sent that to Eugene marais then luckily one of there lawyers was at school with me and she removed the blacklisting for me.

Lots of missions for something so silly.
 
/begin protocol: confused:
IF son admitted and discharged PRIOR to policy amendments, THEN, not your problem, medshield must pay.

IF son admitted without authorisation, THEN member pays in a specified amount.

IF neither condition = TRUE, then totally disregard confused post.

/END confused protocol
 
EnchanterG said:
/begin protocol: confused:
IF son admitted and discharged PRIOR to policy amendments, THEN, not your problem, medshield must pay.

IF son admitted without authorisation, THEN member pays in a specified amount.

IF neither condition = TRUE, then totally disregard confused post.

/END confused protocol
Click to expand...
Condition one TRUE, though it is my problem because I got a second letter of demand and was given 20 days to respond.
So I will pay to avoid this, fight with MediHelp, then GTFO.
 
Most (probably all) hospitals ask you to sign an agreement which renders the patient liable for all costs. If the medical scheme doesn't want to pay then they will send you the bill or demand.

The problems arise when the medical aid sets how much they are willing to pay, which then clashes with how much doctors want.

There is a complex set of codes for every expense, and there is always stuffup with submitting these and the patient ultimately gets the letter some months down the line. The hospital doesn't want to pick up the phone and sort it, and neither does the medical aid, which leaves it in your lap.
 
Lounger said:
There is a complex set of codes for every expense, and there is always stuffup with submitting these and the patient ultimately gets the letter some months down the line. The hospital doesn't want to pick up the phone and sort it, and neither does the medical aid, which leaves it in your lap.
Click to expand...
That's what happened. I did sign that liability agreement form and I almost paid that R950 when I went to inquire about the letter I got. If that lady at the hospital didn't mention that they got new amendments from MediHelp, I probably would have paid right there (though I didn't have the money). So I suppose I owe that lady lunch for her assistance - if the MediHelp refunds me of course.
 
Fuma said:
That's what happened. I did sign that liability agreement form and I almost paid that R950 when I went to inquire about the letter I got. If that lady at the hospital didn't mention that they got new amendments from MediHelp, I probably would have paid right there (though I didn't have the money). So I suppose I owe that lady lunch for her assistance - if the MediHelp refunds me of course.
Click to expand...
take a number, am still waiting for my May refund as well!
 
When i was in SA I had this kind of crap every time with the medical aid. In the UK with the NHS, it's all seameless. We have never had to fork out anything over and above the monthly contribution. The only payment we have to make is £7 for every perscription we collect from the pharmacy. If you are sick you go to your gp, if are you dying you go the A & E. No worries about getting authorisation and pre-authorisation and then wondering if provider is on the "approved" list.

The problem with the medical aid system is that their products are extremely complicated and they change them often. So even if they aren't intentionally trying to rip anyone off, the problems with communicating the rules and rule changes to members and providers is bound to lead to screw ups.
 
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