Specialists charging discovery DOUBLE??

reminds me of a similar incident when I was injured at work - the cost was about R600-00 for treatment & stitches - later when I pointed out that it was a workmens compensation claim it double instantly!
 
Some specialists charge 3 or 4 times the standard rate... just because they can...
And you have to pay the overcharge...
 
Report them to Discovery. They will get kicked off the list of covered specialists if it is not in line the rest of the market.
 
My wife works for one of the larger medical aids as a pharmacist. It is her job to keep track of new medication and negotiate the cost of all medication (this is done yearly, at least). According to her, medical inflation sits around the 13-14% while CPI is closer to 6%. Yet her department has managed to keep the increases on medication below CPI. This means that the doctors are mainly responsible for the high medical inflation.

Also, apparently it is internal policy to keep the doctors happy. When they start charging more, the costs need to be cut somewhere else, typically by trying to cut medication costs.

Now I understand that doctors had to study and work long and hard to get where they are, but it still doesn't justify the rates they charge.
 
Yeah had issues with a specialist at the beginning of the year, they send Discovery this massive bill, Discovery transfers 80% into my account still leaving about R15k outstanding, I phone them and say listen I don't have the 15k and according to their own documentation my wife signed, we should be covered 100%. The receptionist was like oooh yes you're on this plan and yes you should've been charged this amount and and. About 4 bills later all of different amounts it was sorted, they still tried to claim the last bill was wrong and Discovery and myself told them tough, the final bill was paid and if they try again Discovery will take them to some board.
The only good thing is the R60k or so was sitting in my savings while this was going on for three months earning a little interest.
 
The best is when a practitioner tells you they can charge the medical aid directly, which will come out of your savings, but if you pay cash you can settle for much less.

And when you go for any procedure as a medical aid member they itemise and charge ridiculous prices for every cotton swab and glass of water, because they know that as long as the medical aid coughs up, you probably won't bother to even look at the bill in much detail.

This is is why the whole system leads to ever-inflating medical costs. It removes market forces. Practitioners and hospitals just max out what the medical aids will pay and push those limits all the time, and patients don't care because it's not cash out of their pocket. I simply don't understand why medical aids to a large extent just seem to go along with it. If an individual was charged R25 for every glass of ice water they received in hospital many would complain bitterly and word of mouth would get out to avoid that facility, but the medical aids don't seem to apply the same logic - they just pay and increase subs.

The end result is spiralling medical aid subscriptions. I know some families now pay as much as their bond on medical aid subs.
 
garp said:
The best is when a practitioner tells you they can charge the medical aid directly, which will come out of your savings, but if you pay cash you can settle for much less.

And when you go for any procedure as a medical aid member they itemise and charge ridiculous prices for every cotton swab and glass of water, because they know that as long as the medical aid coughs up, you probably won't bother to even look at the bill in much detail.

This is is why the whole system leads to ever-inflating medical costs. It removes market forces. Practitioners and hospitals just max out what the medical aids will pay and push those limits all the time, and patients don't care because it's not cash out of their pocket. I simply don't understand why medical aids to a large extent just seem to go along with it. If an individual was charged R25 for every glass of ice water they received in hospital many would complain bitterly and word of mouth would get out to avoid that facility, but the medical aids don't seem to apply the same logic - they just pay and increase subs.

The end result is spiralling medical aid subscriptions. I know some families now pay as much as their bond on medical aid subs.
Click to expand...

Actually pay more on medical aid then I do for my bond :-(
 
M/A is 9k pm for two of us. I am changing plans next year.
 
Allow me to explain some things to you - do with it what you want.

To the OP - I'm about 99,9% sure your doctor has what is known as a 'payment arrangement' with Discovery, likely the 'Classic Option'. Most surgical specialists I know, have this. This basically means that Discovery will pay you 217% of their base-rate for surgical procedures, as long as you're on the Classic Option. They pay 100% for patients on other options(like Coastal Core) and 100% for consultations. Discovery considers it worth-it, because it means you can't charge them more than that, even for emergency/cancer procedures that sometimes run 400-500%. The doctors consider it worth it, because Discovery pay this money directly into their accounts, bypassing the patient that often holds on to this money. If your doctor was willing to charge Medihelp a different amount, it doesn't make him unethical - quite the opposite. He charges medical aid rates, and would have settled for less money if Medihelp pays less, in stead of charging you the balance.

I strongly disagree with specialists that charge more just because a condition is a PMB(prescribed minimum benefits) or because a patient has gap cover.

As for @garp - seriously guy, somebody has to pay for everything, that's basic economics! Let's say Mediclinic use a 100 000 syringes a day @ R2.50/syringe. That's R250 000/day, or R91 250 000 per year on syringes. Now do the math for alcohol swabs, etc. How many companies do you know that would be willing to take that kind of knock? Would you as a shareholder be happy to know your company's pissing that money away? I doubt it, seeing as you're complaining about paying for a fraction of the price. Furthermore, it's got implications for VAT and income tax as well.

Also, please don't think that you don't pay for 'freebies' like that elsewhere. That cappuccino you're having while having your BMW serviced - worked into the price of the cars they sell. Using serviettes at your local Steers - yes, you guessed it. Even your GP charges you for gloves and syringes, but because someone complained about charging it separately to his medical aid, he's pushed all his consults up by R10 and you're now paying for it out of your own pocket.

Lastly, most people are completely oblivious to the cost of running a medical practice! Average expenses can easily run up to R80k - R100k per month, and then you've still got VAT and income tax to pay as well.
 
There's always that one guy, that will try to defend corruption.
 
ambroseg1 said:
There's always that one guy, that will try to defend corruption.
Click to expand...

No.
Give it some time and another will join the party ;)

@Niner, I hear you. Most businesses need to make profit. But at what point do you stop adding markup? The medical and insurance industries are, probably, the most corrupt non-government organizations in this country.
You say you pay R2.50/syringe but then the patient pays R25 and more for it!
 
Niner said:
Allow me to explain some things to you - do with it what you want.

To the OP - I'm about 99,9% sure your doctor has what is known as a 'payment arrangement' with Discovery, likely the 'Classic Option'. Most surgical specialists I know, have this. This basically means that Discovery will pay you 217% of their base-rate for surgical procedures, as long as you're on the Classic Option. They pay 100% for patients on other options(like Coastal Core) and 100% for consultations. Discovery considers it worth-it, because it means you can't charge them more than that, even for emergency/cancer procedures that sometimes run 400-500%. The doctors consider it worth it, because Discovery pay this money directly into their accounts, bypassing the patient that often holds on to this money. If your doctor was willing to charge Medihelp a different amount, it doesn't make him unethical - quite the opposite. He charges medical aid rates, and would have settled for less money if Medihelp pays less, in stead of charging you the balance.

I strongly disagree with specialists that charge more just because a condition is a PMB(prescribed minimum benefits) or because a patient has gap cover.

As for @garp - seriously guy, somebody has to pay for everything, that's basic economics! Let's say Mediclinic use a 100 000 syringes a day @ R2.50/syringe. That's R250 000/day, or R91 250 000 per year on syringes. Now do the math for alcohol swabs, etc. How many companies do you know that would be willing to take that kind of knock? Would you as a shareholder be happy to know your company's pissing that money away? I doubt it, seeing as you're complaining about paying for a fraction of the price. Furthermore, it's got implications for VAT and income tax as well.

Also, please don't think that you don't pay for 'freebies' like that elsewhere. That cappuccino you're having while having your BMW serviced - worked into the price of the cars they sell. Using serviettes at your local Steers - yes, you guessed it. Even your GP charges you for gloves and syringes, but because someone complained about charging it separately to his medical aid, he's pushed all his consults up by R10 and you're now paying for it out of your own pocket.

Lastly, most people are completely oblivious to the cost of running a medical practice! Average expenses can easily run up to R80k - R100k per month, and then you've still got VAT and income tax to pay as well.
Click to expand...

:crylaugh:
 
Niner said:
Allow me to explain some things to you - do with it what you want.

To the OP - I'm about 99,9% sure your doctor has what is known as a 'payment arrangement' with Discovery, likely the 'Classic Option'. Most surgical specialists I know, have this. This basically means that Discovery will pay you 217% of their base-rate for surgical procedures, as long as you're on the Classic Option. They pay 100% for patients on other options(like Coastal Core) and 100% for consultations. Discovery considers it worth-it, because it means you can't charge them more than that, even for emergency/cancer procedures that sometimes run 400-500%. The doctors consider it worth it, because Discovery pay this money directly into their accounts, bypassing the patient that often holds on to this money. If your doctor was willing to charge Medihelp a different amount, it doesn't make him unethical - quite the opposite. He charges medical aid rates, and would have settled for less money if Medihelp pays less, in stead of charging you the balance.

I strongly disagree with specialists that charge more just because a condition is a PMB(prescribed minimum benefits) or because a patient has gap cover.

As for @garp - seriously guy, somebody has to pay for everything, that's basic economics! Let's say Mediclinic use a 100 000 syringes a day @ R2.50/syringe. That's R250 000/day, or R91 250 000 per year on syringes. Now do the math for alcohol swabs, etc. How many companies do you know that would be willing to take that kind of knock? Would you as a shareholder be happy to know your company's pissing that money away? I doubt it, seeing as you're complaining about paying for a fraction of the price. Furthermore, it's got implications for VAT and income tax as well.

Also, please don't think that you don't pay for 'freebies' like that elsewhere. That cappuccino you're having while having your BMW serviced - worked into the price of the cars they sell. Using serviettes at your local Steers - yes, you guessed it. Even your GP charges you for gloves and syringes, but because someone complained about charging it separately to his medical aid, he's pushed all his consults up by R10 and you're now paying for it out of your own pocket.

Lastly, most people are completely oblivious to the cost of running a medical practice! Average expenses can easily run up to R80k - R100k per month, and then you've still got VAT and income tax to pay as well.
Click to expand...

Tell that to the specialist I know of that just bought himself a R1,500,000 Land Cruiser as his secondary vehicle.
 
SoftDux-Rudi said:
No.
Give it some time and another will join the party ;)

@Niner, I hear you. Most businesses need to make profit. But at what point do you stop adding markup? The medical and insurance industries are, probably, the most corrupt non-government organizations in this country.
You say you pay R2.50/syringe but then the patient pays R25 and more for it!
Click to expand...

Sorry, the R2.50 was a thumb-suck figure. I could probably get you real figures if you wanted them. The point I was actually trying to make, is that these mark-ups happen in every field. Tell me what you do, and I'm sure I'll be able to find examples in your field as well. I'm not denying that there's some corruption, I'm just trying to explain that some of what people consider to be corruption, isn't necessarily so.

At the end of the day, groups like Mediclinic are a business - first and foremost. They want to make money selling a service. Ultimately, if they don't charge you R25 for a R2,50 syringe, they're going to charge you R10025 for you operation, and not R10000.

Also, some patients are as guilty. How do you walk into a doctor's office, for something that isn't an emergency, knowing that you're never going to pay, and don't feel guilty about it? Doctor's sell their time, so you can argue it's sort-of like theft. And then, after you've been handed over, you have the balls to go back to that same doctor, and expect to be treated again? Then there's my favourite - doctor, I can't afford these blood tests/sonar right now, and my savings are exhausted - can't you admit me so they can come from my hospital plan? THAT's UNETHICAL!! and corrupt!

Let's look at the car industry - just an example. You can buy an A4 with trade-in assistance to the value of R100 000. If you bought this car last month when they didn't offer the trade-in assistance, you would have paid R100k more for it. But nobody complains, because it's a 'luxury car'. You can get a VW Polo for a hell of lot less, that will also get you from point A to Point B, but that A4 will do it a lot nicer. Private healthcare is exactly the same concept - you pay a premium for what should be a better service. And if you're not getting a better service, then by all means complain! And shop around, especially for elective procedures. If your kid's had it's third bout of tonsillitis in the last year, and the tonsils are likely to come out - call all the ENT's in a 10 mile radius and get a quote from them. It's really not that hard. And if they're not willing to do one for you, you're probably better off avoiding them in the first place.
 
Blu82 said:
Tell that to the specialist I know of that just bought himself a R1,500,000 Land Cruiser as his secondary vehicle.
Click to expand...

I'm not saying some guys don't make a lot of money, I'm just trying to explain that you don't have to be corrupt to do so. Also, who are you to decide how much he's allowed to get?
 
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