And how much they're making from that administration should be closely scrutinised.
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Question of the Day: If you were buying a TV today, which brand would you choose?
Why Discovery is so expensive
- Thread starter Kevin Lancaster
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- discovery
NarrowBandFtw
Honorary Master
Oh no, they are quite necessary, because you refuse to pay for any "out-of-hospital" procedures on pretty much all of your plans it has become necessary to spend at least one day in the hospital to avoid a huge medical bill ...
They should not be allowed to charge different rates based on the fact who is paying. Also rates should be available and easy to understand before proceeding with anything. In the above mentioned instance I wonder if the client would have been able to pay the R4000 and claim it back from the aid?
Arthur
Honorary Master
I agree it would be convenient if rates were standardised.
But please not by government fatwa.
That would force my township doctor to charge the same as the downtown doctors, whereas today he's half the price and twice as good. I pay cash, and don't have medical aid cover for ornery doctor visits.
A free market is preferable anyday.
But please not by government fatwa.
That would force my township doctor to charge the same as the downtown doctors, whereas today he's half the price and twice as good. I pay cash, and don't have medical aid cover for ornery doctor visits.
A free market is preferable anyday.
blowdart18
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Had a bike accident on the way to work in the morning, paramedics insisted I get to a hospital to do a check up because my Adrenalin was pumping.
Arrive at the hospital accident unit, had x-rays and CT done, and finally discharged the same day with some pain killers.
Get an sms a week later saying that everything is coming from my MSA.
Phoned and asked why the hell is everything coming from MSA, was kindly told by Discovery:
"The amount was taken from your MSA because you were booked into a private practice, we do acknowledge that you were in an accident but due to the fact that your injuries were not life threatening you were not actually admitted to the hospital, so the funds came from your MSA and not your hospital benefit"
Ok fine . . . Next time I will make up any possible pain possible to be booked into hospital thank you very much.
At the time it was almost R9000 from my MSA, after the bike accident I had no money for any other day to day problems.
Arrive at the hospital accident unit, had x-rays and CT done, and finally discharged the same day with some pain killers.
Get an sms a week later saying that everything is coming from my MSA.
Phoned and asked why the hell is everything coming from MSA, was kindly told by Discovery:
"The amount was taken from your MSA because you were booked into a private practice, we do acknowledge that you were in an accident but due to the fact that your injuries were not life threatening you were not actually admitted to the hospital, so the funds came from your MSA and not your hospital benefit"
Ok fine . . . Next time I will make up any possible pain possible to be booked into hospital thank you very much.
At the time it was almost R9000 from my MSA, after the bike accident I had no money for any other day to day problems.
cerebus
Honorary Master
So all we need to do to bring our MA costs down is get a more premium Discovery package and then not use it??? Why didn't they tell me this!
Can MBB post an article comparing the prices of various medical aids? I mean I know each have their various plans, maybe we could compare plans of a similar level?
I've never really looked at other medical aids, so I'd be interested to know the price difference.
I've never really looked at other medical aids, so I'd be interested to know the price difference.
cybershark
Expert Member
Now you see why gov is talking about NHI. What is it going to take for the rates to be standardised? If, not by now, I don't see how the industry would suddenly start self-regulating themselves?
Yeah, an ER unit is the same as a doctor's office. This is something that should be common knowledge.
blowdart18
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Yeah, what I am trying to highlight is how many people have gone through this and had their fingers burnt.
Yes I was ignorant to expect it from them in the first place, but last thing you are thinking about after leaving the hospital after a bike accident is Medical savings account . . . . You expect to be covered for something like that if you forking out the monthly premiums.
That's why I wouldn't be surprised if people exaggerate their injuries so they booked into the hospital.
Interesting, considering Discovery paid everything for my 3 hours at ER after breaking a finger, from my hospital benefit.
Follow ups with specialists, do however come from my MSA.
It's amazing how people will join a medical aid and not know what they're covered for. Also, how do you go for a procedure if you don't know what's likely to be covered and not? You buy a car, you sign an offer to purchase. You go onto an online calculator and you calculate how much your installment and insurance will be, and you decide whether you can afford it or not. Why not do the same with healthcare?
My patients get detailed quotes, stating how much I charge for a procedure and how much the medical aid should pay and what their shortfall is likely to be. If they settle their entire account upfront, or within 14 days of the procedure and then claim from the medical aid, they get 15% discount. Worth it for me knowing I don't have to wait 2-3 months for the money.
As for standardized rates - won't happen. If it does happen, we're likely to see the collapse of healthcare in this country. Same thing if NHI comes in. If doctors decide they're not happy with the rates, they'll pack up and go. And less doctors will train as well. It's not about greed - you need to be able to provide for your family and give them the quality of life you feel they deserve.
Then, bare in mind, that at some point, people's funds are exhausted. Now you need to claim the money back from them directly. So, even if you charge medical aid rates, you're still going to have bad debt.
And for the record, we're not all driving Porsches. I'm a specialist in private practice and my wife(a medical officer in a government hospital) still takes home more than me.
My patients get detailed quotes, stating how much I charge for a procedure and how much the medical aid should pay and what their shortfall is likely to be. If they settle their entire account upfront, or within 14 days of the procedure and then claim from the medical aid, they get 15% discount. Worth it for me knowing I don't have to wait 2-3 months for the money.
As for standardized rates - won't happen. If it does happen, we're likely to see the collapse of healthcare in this country. Same thing if NHI comes in. If doctors decide they're not happy with the rates, they'll pack up and go. And less doctors will train as well. It's not about greed - you need to be able to provide for your family and give them the quality of life you feel they deserve.
Then, bare in mind, that at some point, people's funds are exhausted. Now you need to claim the money back from them directly. So, even if you charge medical aid rates, you're still going to have bad debt.
And for the record, we're not all driving Porsches. I'm a specialist in private practice and my wife(a medical officer in a government hospital) still takes home more than me.
redspark
Expert Member
:wtf:
bumbledore
Senior Member
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The true cost of a hospital plan in RSA is R515.
Anything over and above that, you are getting ripped off - especially so with Discovery's "bloatware" attached to their plans.
Anything over and above that, you are getting ripped off - especially so with Discovery's "bloatware" attached to their plans.
Somewhere in all of this you were "admitted" to hospital, whether you actually were or if it's just on paper is a different matter. If you aren't admitted then it's not hospital.
Sodan
Expert Member
I'm sure you're aware that:
1) The medical aids' rules/codes/procedure names are somewhat cryptic to the layman
2) Medical Aids have 100% of their rate, 200% of their rate, etc on whichever plan, and that 100% of one medical aid's rate may not be the same as 100% of another medical aid's rate
3) they (well, Discovery, in my experience) change their rules/codes/whatever that gets covered, and by how much, from time to time, sometimes for obscure procedures that normal people can't pronounce, until they need that particular procedure/operation.
In the case of buying the vehicle, there is only 1 variable to consider that may change outside of the prospective purchaser's control - interest rate. In the case of medical aid, there are tons, a fair amount of them being meaningless (to the layman) procedure names/ailments.
It is thus not so surprising that people don't actually know what they're covered. Hell, when I had my haemorrhoidectamy about a month ago (most painful and miserable time of my life!
), even my anaethetist was complaining about having to foot the bill for some dental surgery he had had that his medical aid refused to cover! What chance do the rest of us have?!Sodan
Expert Member
Please elaborate. Can you perhaps tell us which medical scheme has a comprehensive hospital plan for R515?
ThinkCentre
Expert Member
I have no problem paying a bit more! People who might misuse their medical aid are more prone to use the cheapest medical aid!
I'm sure you're aware that:
1) The medical aids' rules/codes/procedure names are somewhat cryptic to the layman
2) Medical Aids have 100% of their rate, 200% of their rate, etc on whichever plan, and that 100% of one medical aid's rate may not be the same as 100% of another medical aid's rate
3) they (well, Discovery, in my experience) change their rules/codes/whatever that gets covered, and by how much, from time to time, sometimes for obscure procedures that normal people can't pronounce, until they need that particular procedure/operation.
In the case of buying the vehicle, there is only 1 variable to consider that may change outside of the prospective purchaser's control - interest rate. In the case of medical aid, there are tons, a fair amount of them being meaningless (to the layman) procedure names/ailments.
It is thus not so surprising that people don't actually know what they're covered. Hell, when I had my haemorrhoidectamy about a month ago (most painful and miserable time of my life!
I understand that, but a GOOD broker should be able to explain these to you. The biggest scam they came up with is - 'don't worry, we'll cover that 100%, no problem'. That means at their rates, not whatever the doctor charges.
Word of advice - always ask how much consults are before going and ALWAYS ask for a quote before surgery! Also, it's impossible to put up a list of all tariffs for all medical aids - it would be about 10 pages per medical aid, and they're in code form.
If anybody wants the medical aid rate for a specific procedure, ask here and I'll see if I can give it.