Medical Aid

I've said it before and I'll say it again, gap cover does nothing except allow medical people to charge you *more* because they *know* you can pay it.

Your choice of course.
 
You don't believe me.

Try this sometime. When you next need some medical attention, tell the person you're going to that you don't have medical aid and you need to negotiate on a price.

Top-tier doctors will usually just show you the door, but middle-of-the-road ones will often give a discount. I've done it. More than once. If you have medical aid and gap cover though, they won't hear of it, they'll take as much as they can get.
 
newby_investor said:
You don't believe me.

Try this sometime. When you next need some medical attention, tell the person you're going to that you don't have medical aid and you need to negotiate on a price.

Top-tier doctors will usually just show you the door, but middle-of-the-road ones will often give a discount. I've done it. More than once. If you have medical aid and gap cover though, they won't hear of it, they'll take as much as they can get.
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This. I have said before to a specialist in hospital I am private patient. They billed me x amount. When I claimed the amount, discovery paid it direct to them by mistake. The specialist reversed the claim and charged R3K extra.
 
newby_investor said:
You don't believe me.

Try this sometime. When you next need some medical attention, tell the person you're going to that you don't have medical aid and you need to negotiate on a price.

Top-tier doctors will usually just show you the door, but middle-of-the-road ones will often give a discount. I've done it. More than once. If you have medical aid and gap cover though, they won't hear of it, they'll take as much as they can get.
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I guess you do get some money making doctors, but that being said.. I've gone to the same doctors for years, they know my medical history... When it comes to health, I don't care about the cost, I care about the outcome and thankfully for medical aid and gap cover, I can go to a Top-tier doctor and not have to worry about either
 
Recallza said:
I guess you do get some money making doctors, but that being said.. I've gone to the same doctors for years, they know my medical history... When it comes to health, I don't care about the cost, I care about the outcome and thankfully for medical aid and gap cover, I can go to a Top-tier doctor and not have to worry about either
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This is a personal choice I guess, but it's one of those things that's very good for an individual person but not great for society as a whole.

Interesting fact on the side. Price tags were invented by the Quakers because they believed it was immoral to charge different prices to different people.
 
I.am.Sam said:
Hello all,

Another medical aid thread

I am on the classic smart plan at discovery and was wondering how can i save further

Any other medical aids with just a basic good hospital plan

Currently paying 4642 for 2 adults and 2 kids. Need to save more money :)
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So what about the load of money you paid in already...??
Modern medical aids will continiuously change their rules and plans making it more expensive way above inflation every year, forcing you down the plans, pocket your money, and when old and need it the most they will force you out after years of paying in. What happens here over TIME is poorly understood.
 
I.am.Sam said:
most doctors and specialists charge more than 100% towards medical aid

cash is another story
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So what if a plan only covers 100% but doctor charge 200% plus for medical aids , will the doctor know your plan only covers 100% and still charge you 200%? So you will always then pay the fee you would have paid anyways + pay a medical aid?
 
RedViking said:
Who you suggest for gap cover besides discovery?
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I think mine is with Sirago, boosts your cover to 500% medical aid rates. Also has a whole raft of side benefits, incl emergency room cover and some scans, R310/pm though
newby_investor said:
I've said it before and I'll say it again, gap cover does nothing except allow medical people to charge you *more* because they *know* you can pay it.

Your choice of course.
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Wtf, that's a load of rubbish.

Gap cover has zero to do with the doctor or any other medical service provider(incl your medical aid), you aren't obliged to disclose that you have gap cover to them and its advisable not to. Its even independent of your medical aid, you submit your claims to the gap cover after the fact, no one else needs to know you have gap cover but your self.

It's true that some practitioners may inflate bills if they know your medical aid policy can afford it and/or your gap cover but that's why if you are wise you don't disclose that info unless necessary.
 
newby_investor said:
I've said it before and I'll say it again, gap cover does nothing except allow medical people to charge you *more* because they *know* you can pay it.

Your choice of course.
Click to expand...

Nonsense.

Doctors don’t have special pricing for every person who rocks up at their door.

Firstly they like money too much and will charge what they charge regardless.

Secondly, they already hate admin and paperwork so imagine having to deal with that ****.

The only thing that happens when you advise them that you have gap cover is that they provide the report and all related documentation you need for you gap cover claim up front or upon invoicing, without you having to ask for it later down the line when you wake up to needing it.

And this is from someone who went without gap cover for years and upon seeing the light it has paid for itself annually and basically saved me thousands without costing me anything in real terms.
 
RedViking said:
Who you suggest for gap cover besides discovery?
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You could have a look at the GTC survey of gap cover options. They believe Sanlam Gap Cover (which is basically just Centriq/Xelus) offers the best value if you are under 55 or 60 (can't remember what the threshold is exactly).
I'm with Sanlam, but would have preferred Stratum Benefits. Stratum may be slightly more expensive, but they have fewer exclusions.
http://www.gtc.co.za/wp-content/uploads/2018/06/GTC-GAP-SURVEY-2018-rev-1.pdf
 
I.am.Sam said:
anyone with feedback around other medical aids ?
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Please stay away from Genesis, or any tiny scheme for that matter, but in particular Genesis. Genesis is constantly in court about their refusal to pay the most basic benefits. Just Google them. They even tried to make state hospitals the only designated service-provider for ALL prescribed minimum benefits... And with a R50 000 limit for procedures which are not PMBs, you might just as well have no cover. My mother had a spinal operation last year. Just the doctors charged far more than R150 000.

Discovery is at the lower end of your premium scale...

If people really want to squeeze a buck or two, you can consider Bestmed. Their Pace series are entry-level plans.
 
Sputnik100 said:
Please stay away from Genesis, or any tiny scheme for that matter, but in particular Genesis. Genesis is constantly in court about their refusal to pay the most basic benefits. Just Google them. They even tried to make state hospitals the only designated service-provider for ALL prescribed minimum benefits... And with a R50 000 limit for procedures which are not PMBs, you might just as well have no cover. My mother had a spinal operation last year. Just the doctors charged far more than R150 000.

Discovery is at the lower end of your premium scale...

If people really want to squeeze a buck or two, you can consider Bestmed. Their Pace series are entry-level plans.
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Do you have any proof of this?
 
Thor said:
Do you have any proof of this?
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Absolutely.

There is a ton of rulings from the Medical Schemes Tribunal involving Genesis.

If you simply look at the latest annual report from the Council for Medical Schemes, you'll see which schemes have the most VALID complaints per 1000 members.
They are:

1. Spectramed (4,4 per 1000 members) -- merged with Resolution Health in 2019.
2. COMMED (2,8) -- under curatorship
3. Resolution Health (2,6) -- merged with Spectramed to form Health Squared in 2019
4. Genesis (2,1)
5. Suremed (1,6)
6. Fedhealth (1,4)
7. Sizwe (1,2)
8. Keyhealth (1,1)
9. Medihelp (1,1)
10. Hosmed (0,9)

Again, stay away from the tiny funds... You hear MANY complaints about Discovery and Bonitas, etc., but it is because they have so many members. You have to compare apples with apples.


RE: Court cases

The Council for Medical Schemes v Genesis Medical Scheme, 2016, Constitutional Court.
Genesis fought up to the highest court in the land to escape paying for prescribed minimum conditions.
The court held:
“The relationship between a medical scheme on the one hand and its members on the other, is not governed solely by that scheme’s rules but also by the obligations imposed by statute upon medical schemes. These latter obligations cannot be evaded by a medical scheme purporting to contract with its members by prescribing rules having a contrary effect.”
The court blasted Genesis.
http://www.saflii.org/za/cases/ZASCA/2015/161.pdf

Registrar of Medical Schemes v Genesis, 2017, Gauteng North High Court
Council wanted Genesis to remove a number of claims and statements from its website within 24 hours.
http://www.saflii.org/cgi-bin/disp.pl?file=za/cases/ZAGPPHC/2017/78.html&query=Genesis


Genesis Medical Scheme v Registrar of Medical Schemes, 2014, Cape Town High Court.
Scheme took the Council for Medical Schemes to court as the latter would not accept the correctness of their financial statements.
http://www.saflii.org/cgi-bin/disp.pl?file=za/cases/ZAWCHC/2014/206.html&query=Genesis

Genesis Medical Scheme v Registrar and Another, 2017, Constitutional Court.
Fight about whether amounts in your medical savings account belongs to you or to the fund. Genesis said it belongs to the fund.
http://www.saflii.org/cgi-bin/disp.pl?file=za/cases/ZACC/2017/16.html&query=Genesis

Genesis Medical Scheme v McCarthy Limited, 2009, KZN High Court.
Medical scheme got into protracted litigation with their members' fees in an attempt to recover money from McCarthy after an injury to one of their members.
http://www.saflii.org/cgi-bin/disp.pl?file=za/cases/ZAKZDHC/2017/4.html&query=Genesis
 
I.am.Sam said:
yeah sadly if you do end up in an accident or get some sickness you in trouble

thats why a bare minimum hospital plan is good enough
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That's what I thought.

Ended up in emergency two months back after I had an accident with a hobby knife. I had to pay R1500 to get treatment as it did not require an overnight stay.

If I did not have the money, then I would have been screwed. Got 8 stitches and no longterm damage, if I went to state hospital I would have had to wait till the next day and then would have complications.

Hospital plans don't hold the same value today as what they did 10 years back. Back then I use to walk into the hospital when a kid sneezed and everything got covered, today a planned procedure that should have required hospitalisation gets rejected by the hospital plan.

I'm now putting away money into an emergency savings account for the next medical incident.
 
RedViking said:
Check out Genesis. They look great looking at price and benefits on paper.
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Yeah, I was on them and what you say is true, however, their service is utter garbage, they will find any reason to tack an exclusion when you want to claim something or get a pre-authorisation, so whilst I would recommend them on price, make sure you read the T&C's extra closely before signing up.

Oh, I see post #36 covers it. Run away.
 
Whilst we are on this topic, I have a medical insurance that covers 100% of my day to day needs. I've been with them for two years and am very happy so far. What I am looking for is a good and cheap hospital only cover?
 
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