Medical Aid!

jingaling said:
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What the government should be doing is regulating the fees charged by healthcare professionals. There is currently no law preventing them from charging a variance in rates from one patient to the next, and charging any fee. And of course people often don’t often negotiate with the practitioner to charge medical aid rates, even for planned procedures.
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It would definitely be nice if the fees specialists charge were regulated. We ended up with a 12k bill last year...that was just for the portion of the specialist's fee that was not covered.Only found out about gap cover after joining Mybb :(
If you are going in for a planned procedure, you might want to phone your medical aid and find out which specialists are affiliated with your medical aid and charge medical aid rates.
 
regulating the fee will just drive the practitioners away. If you where a specialist earning a good living and suddenly the government cut your earnings by 66% you would probably leave to another country where its more free market based. Seriously, regulation is hurting the healthcare space, not helping.

Anyways, I recently upgraded from hospital plan to full medical aid and am glad I did. We are definitely getting full value out of it.
 
Cius said:
regulating the fee will just drive the practitioners away. If you where a specialist earning a good living and suddenly the government cut your earnings by 66% you would probably leave to another country where its more free market based. Seriously, regulation is hurting the healthcare space, not helping.

Anyways, I recently upgraded from hospital plan to full medical aid and am glad I did. We are definitely getting full value out of it.
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Yes, but some specialists take advantage of the fact there's no regulation. My son had to go in for an emergency op for dislocation and fracture of his elbow.Two hour operation, one night stay in hospital.
The specialist's fee was R 15000. The cost of using the theatre and one nights stay at hospital was R 15000. Medical aid covered the cost fully for the hospital stay and only paid R 5000 for the specialist, since he charged 300% of medical aid rates.
When I phoned to query, the doctor's accountant tells me normally in emergency cases, medical aid does not question the bill...they pay fully. Doctor sounded greedy to me. Six months later we had to pay another R 2000 out of pocket for the specialist to remove the pin from my son's elbow.
 
The medical field is not one that lends itself to comparison shopping and bargaining. It thus makes good sense for costs to be regulated.

alkit said:
So, before I signed up to my hospital plan, I asked my broker, "If I need an MRI without being admitted to hospital, will they cover me". He replied, "yes". A few months later (as fate would have it), I needed to get an MRI, and was told by Discovery that MRIs are only covered if you have a savings plan in addition to the hospital plan. So I had to pay R10k out of pocket.
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Medical savings is still paying out of your own pocket. I view it as a scam to make it look like the medical aid covers more than they really do. When I look at typical comprehensive plans I find I have to spend quite a lot of my own money in addition to the premiums before the medical aid really pays anything.
 
Some brokers will also tell you that once you've been admitted into hospital, you are covered a 100%...neglecting to mention that it's a 100% at medical aid rates.
 
I've never had a problem with providers charging above medical aid rates. Even though they provide an essential service, making sure there are no unforeseen additional costs is important. Negotiating with the provider upfront is key. If they are not willing to charge medical aid rates I choose another that is willing to, including anaesthetists.

Only once experienced a problem when I ran out of benefits. The provider's billing company decided to change the fees to private rate, which was 3 times the medical aid rate, an addtional R2400. It took a few months to sort out, and was almost grey listed. It was resolved after I threatened to take the matter to HPCSA.

Just because a doctor charges above medical aid rates does not make him/her better skilled or qualified than the next. In fact there are brilliant specialists that work in public hospitals, and their income is not as substantial as the specialists in the private sector.
 
jingaling said:
Just because a doctor charges above medical aid rates does not make him/her better skilled or qualified than the next. In fact there are brilliant specialists that work in public hospitals, and their income is not as substantial as the specialists in the private sector.
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I agree that a lot of the time, specialists working in public are just as good, better even, than those in private. But the condition of state hospitals are pathetic...and running out of certain supplies is a regular occurrence. I would not want to risk that.

The people working at my medical aid's call centre are the absolute worst...when I asked what specialists/hospitals are they affiliated with, and will charge medical aid rates, they couldn't give me an answer. They just said that my scheme allows me to go anywhere.
 
Ms_S said:
I agree that a lot of the time, specialists working in public are just as good, better even, than those in private. But the condition of state hospitals are pathetic...and running out of certain supplies is a regular occurrence. I would not want to risk that.

The people working at my medical aid's call centre are the absolute worst...when I asked what specialists/hospitals are they affiliated with, and will charge medical aid rates, they couldn't give me an answer. They just said that my scheme allows me to go anywhere.
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True, not all schemes have contracted with specialists/hospitals networks, which is a concern. A grey area in the Medical Schemes Act means schemes have to fork out whatever the cost providers charge for PMB's, causing a additional drain on the schemes' financial resources if they have not created any networks.

https://www.bhfglobal.com/medical-aids-cry-foul-over-benefits-law-310812
 
Kosmik said:
Maybe medical aids should bring back the medic alert bracelets.
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They never went away, instead there are newer products and competitors on the market. They make them colourful and train the ambulance staff to not only identify them but how to retrieve the required information.
 
MightyQuin said:
I'm with Discovery. I have had to make 2 claims from GAP Cover during the last year and half...both for ops om my kids (grommets). Absolutely no hassles and very quick payment.
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I'm with Discovery and my daughter got hospitalised a few weeks back and they paid 100% - first time in years. Since the new rates got published, the medical industry has gone back to charging normal rates.
 
I would also like to add that you must develop a relationship with the hospital you will most likely be admitted to. Get the numbers, get the numbers of the doctors, make sure they have your details up to date. It costs nothing to go in even on a Saturday and get your details captured on their system - same applies to your GP and any other specialist you may use.

Also ask them what are their procedures for admittance and even find out the layout of wards.

Once again my daughter was hospitalised last week and after too many hospitalisations we know the drill. We know what to ask and we are never afraid to ask if they can get it covered by the medical aid. Last weeks visit cost just under R10K and we only paid in R400 for medicine that we had to administor at home. We only have a hospital plan without savings.
 
The most valuable thing I have learned to date is to NEVER skimp on your medical aid and your car insurance, sure not everyone can spend the same amount on the products but in my experience you just can't afford not to have good insurance and medical aid! Been with Discovery back in the day but always had issues with them and everyday I hear some troubling stories with Discovery(eg not paying chronic medication or just a certain amount or this sneaky limit or that etc etc) so I changed to CAMAF (http://www.camaf.co.za/), best experience thus far with them but only catch is you need to be a registered professional like an accountant or engineer with recognized firm etc. I might be looking to get some GAP cover as well = sorted for any unexpected hiccup but struggling to find a great supplier who doesn't have too much small print etc, any options?
 
Hi Guys

Slight derail in this topic, but I spend most of my year out of the country on temporary work visas. So I'll head out and then come back after 4 or 5 months, for a few weeks, and then head back out again for the odd month or 2 or 3, depending on the job. The problem I have is finding a medical aid that would cover me. Any suggestions?

I seem to hit a wall, typically because my salary is paid by the foreign company, throughout the year. Even when I'm back in SA (sort of as a retainer amount). Its made worse by the fact that I can't get medical aid over there, since I'm on temporary work visas each time. And the catch is, the wife is typically included on my visa, which means that she comes with each time. Hence also the reason why I don't have a name on a rental agreement, as we simply rent my in-laws garden apartment when we are back in SA.

So, again, anybody know of any medical aids that will cover us in this type of situation? Its not like we're going to be working like this permanently, and in fact plan to return to SA towards the end of next year or during 2014 to start settling.
 
Reminder about this guys! Make sure you carry your medical aid cards on you all the time - if you have family ON the same medical aid, make sure they also have cards!!!

I did a call just the other day - I had to take the guy to New Somerset Hospital because he didn't have his medical aid card - his friends collected him and took him to a different hospital later - this obviously delayed treatment he needed and I couldn't do anything about it (initially!)

Please... don't forget!
 
gdiza said:
Reminder about this guys! Make sure you carry your medical aid cards on you all the time - if you have family ON the same medical aid, make sure they also have cards!!!

I did a call just the other day - I had to take the guy to New Somerset Hospital because he didn't have his medical aid card - his friends collected him and took him to a different hospital later - this obviously delayed treatment he needed and I couldn't do anything about it (initially!)

Please... don't forget!
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Hey gdiza, on that I see Discovery have printed out these medical "license disc" images that we can stick now on the front of our cars. Apparently you guys can now scan that and get our details? Any experiance with it?
 
gdiza said:
Reminder about this guys! Make sure you carry your medical aid cards on you all the time - if you have family ON the same medical aid, make sure they also have cards!!!

I did a call just the other day - I had to take the guy to New Somerset Hospital because he didn't have his medical aid card - his friends collected him and took him to a different hospital later - this obviously delayed treatment he needed and I couldn't do anything about it (initially!)

Please... don't forget!
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If I could speak & move I'd grab you by the throat and demand you take me to a private hospital and then I'd tell the finance vultures there to phone the F&%&G medical aid to get verification.;)
 
Pre-authorise everything with your Medical Aid, it's as simple as that.

Then there can't be any surprises.
 
noxibox said:
The medical field is not one that lends itself to comparison shopping and bargaining. It thus makes good sense for costs to be regulated.


Medical savings is still paying out of your own pocket. I view it as a scam to make it look like the medical aid covers more than they really do. When I look at typical comprehensive plans I find I have to spend quite a lot of my own money in addition to the premiums before the medical aid really pays anything.
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That's quite true. with Discovery, for example, everything, day to day, comes out of Savings to a predetermined amount say between 5k and 15K and then you hit a wall when you've exhausted that amount and you have to pay out of your own pocket anywhere from 4k 5k 6k before your savings kicks in again... it could take a while ...but the catch is...when you finally catch up and make "threshold" as they call it ... they only pay 70% of prescribed meds so you will always have a shortfall to pay and most people exhaust their savings in the first 4-5 months of the year-last time I heard.
 
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