Why do doctors know so little about medical aid?

Forgive me for a little rant.

Doctors must be one of the ONLY professions where they simultaneously have sworn an oath to look after their patients' health, while simultaneously pay zero attention to their patients' financial health.

Honestly, I was in a doctor's room today who wanted to book my wife into his hospital, and looked at me blankly when I said "Oh wait, we're not covered for this hospital because it's not part of Discovery's Delta network, can't you admit my wife into another hospital instead please?"

He admitted to not having a clue about "any of that" and not knowing any of the doctors outside of his own hospital who he could phone to get my wife admitted in such a way that it would be covered by Discovery.

Tell me honestly, what kind of business operates with so little knowledge of its own client's financial well-being and decisions? What that doctor was trying to do effectively would have cost me R7 100 penalty fee for a planned admission into a non-Delta hospital ... and all because the doctor (a highly-skilled specialist - not just a GP even) knows about every part of his patient's body but somehow forgot that they also worry about a little thing called "money"?

I ask you, with tears in my eyes, how? Is this because doctors earn so much money that they've forgotten that the rest of the world isn't quite as fortunate? Ironically, another specialist I know is HERSELF on the Delta plan with Discovery, and it's honestly not like 'Discovery' or even 'the Delta network' is an unknown quantity in South Africa.

But wait, there's more. In the end the doctor had some tests done on my wife, decided it wasn't an emergency, and agreed to get her admitted into a Delta hospital nearby ... catch being that he asked her to just come in on Monday and "everything would be sorted". That's fine, EXCEPT he omitted to remind her to phone Discovery because Discovery requires a 48-hour notice to pre-authorise any planned admissions, failing which they'll only pay 70% of the resulting claim.

Don't get me wrong: I am not saying I wasn't in responsible in this. I WAS, which is why I knew about the Delta network penalty fee AND the 48-hour waiting period. What I object to, however, is doctors' (and it's definitely not just this doctor) complete disinterest in helping to save their clients money through some common sense advice and planning. It's that little thing called 'client care', but somehow doctors absolve themselves from this by calling their clients 'patients'.

Anybody feel my pain above?

If somehow you're a doctor reading this, all I ask is that you at least think about how your patients will afford the care you're trying to give them. We're in South Africa. We're human. Money does count, and when cheaper alternatives exist it'd be appreciated if you are able to recommend them (especially because you as a doctor are always dealing with hospital admissions and I personally NEVER have before).

TLDR: Doctors really ought to have some idea of the cost of the treatments they're prescribing and be able to care about their patients' financial well-being as well as their physical well-being. It's a basic principle of client care: ensure you don't bankrupt those relying on your help.

I don't think its the doctor's problem.

Foxhound5366 said:

I ask you, with tears in my eyes, how? Is this because doctors earn so much money that they've forgotten that the rest of the world isn't quite as fortunate? Ironically, another specialist I know is HERSELF on the Delta plan with Discovery, and it's honestly not like 'Discovery' or even 'the Delta network' is an unknown quantity in South Africa.

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I suspect this is exactly it, especially so with specialists.

They are completely out of touch with reality and because medical aids just keep on paying them (I mean they don't know if it comes off your plan or MSA) they just keep charging more.

That being said maybe it's just the way your post is structured but usually the doctor's aren't "hands on" with booking people into hospital and only give the instruction.

I'm guessing you specifically went to this specialist who just happens to be at this hospital, otherwise you would have been at a Delta hospital in the first place.

Not once have I ever had to personally arrange the pre-authorization for any hospital visit and we've had a few in the last few years. It's all been sorted out by the hospital every time.


But almost off topic the entire industry's "costs" are a ****ing sham.

saturnz said:

I don't think its the doctor's problem.

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Like I said somewhere near the end, really?

Why should 'financial health' be deemed to be part and parcel of 'physical health'? If a doctor - through an inability to advise on the financial implications of their own advise - ends up bankrupting or severely damaging the finances of their clients (especially when had they known they might easily have given some different advice that would have not impacted the actual healthcare they were trying to provide), then isn't that a Very Bad Thing?

When I go to a doctor I do NOT give them a permission to just bend me over their table and charge me whatever they want. Just because they're now advising me to go to somebody else similarly doesn't suddenly mean that they ARE allowed to not give a damn.

It's not the doctors responsibility to know what your financial capabilities are. They aren't financial advisors after all.

You can ask doctors for quotes for most planned procedures\treatments etc. For example, we went to a specific gynie and they gave us a cost breakdown of how many vists as well as tests etc for the whole time period. Same when we went for infertility treatment. To be honest though, this was run by the admin and accounts folks more than the doc himself although he obviously advises a treatment plan.

It's not the Dr responsibility to be aware of medical plans and such . Just think if they had to memorize all the medical plans and schemes. Feck that.

SauRoNZA said:

Not once have I ever had to personally arrange the pre-authorization for any hospital visit and we've had a few in the last few years. It's all been sorted out by the hospital every time.

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Yeah, without getting into the details my wife needs some preventative procedure for a situation that isn't a crisis yet (i.e. if we'd been booked directly into the hospital on a regular ICD10 code and not an emergency one we'd have been nailed for that too). And yeah, we just got referred to this specific doctor by another doctor who got us an urgent appointment with him (otherwise we'd have waited a month to see him) and so we didn't get the luxury of choosing a doctor within the Delta network (which usually we don't care about because consultation fees normally just come out of our medical savings anyway).

Just as a side note, I'd had no clue about all the codes you need for these things. You need the practice codes for your doctor and the hospital, and the codes for both the diagnosis (ICD10) AND the procedures that will be carried out (RPL). In addition to learning that, I also discovered that if you phone Discovery they can pre-load whatever details you have into the system and we can then phone them on Monday with the rest of the details, and even though that's the day of the procedure we won't be penalised because at least we phoned 48 hours before to start the process.

Moral of the story: if in doubt, phone Discovery first.

crackersa said:

It's not the Dr responsibility to be aware of medical plans and such . Just think if they had to memorize all the medical plans and schemes. Feck that.

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Who said anything about memorize? Do you think doctors memorize ALL medication? Have you never been in a doctor's room when the doctor opens a book to page through it to read up about whatever medication you're currently taking?

In fact, there's a very good idea for a simple application, if any budding app developer on here wants to try it out: just create a simple 'pre-admission screening' program that doctors can plug their patient's medical aid plan into and the procedure they need, and it will give a list of the nearest hospitals that fall within that plan's coverage. It's data, not rocket science.

Kosmik said:

You can ask doctors for quotes for most planned procedures\treatments etc. For example, we went to a specific gynie and they gave us a cost breakdown of how many vists as well as tests etc for the whole time period. Same when we went for infertility treatment. To be honest though, this was run by the admin and accounts folks more than the doc himself although he obviously advises a treatment plan.

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Yeah that's helpful for if it's a procedure that that doctor will be doing themselves. When the doctor happens to be getting a patient admitted into the hospital with another doctor, then they (nor their accounts staff) would be any help with determining those costs.

marioat1 said:

It's not the doctors responsibility to know what your financial capabilities are. They aren't financial advisors after all.

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Where else in business would you apply that philosophy? When you go to a doctor you pay them money, therefore it's a business transaction and not charity.

"I don't need to know if my clients can afford me or what I'm recommending to them."

What makes it worse is in the case of a doctor, where the patient chooses a doctor because they can afford that doctor, and then the doctor goes and decides to get the patient admitted somewhere else that's needlessly expensive when much better alternatives exist (if only the doctor bothered to know about it - or have some basic reference material on-hand). Hell, I'd even have settled for the doctor saying "Ok guys, I'd recommend doing X. Can you please phone your medical aid and check if you're covered for this?" But no, the doctor just picked up the phone and started getting my wife booked in all by himself, before I stopped him.

Foxhound5366 said:

Who said anything about memorize? Do you think doctors memorize ALL medication? Have you never been in a doctor's room when the doctor opens a book to page through it to read up about whatever medication you're currently taking?

In fact, there's a very good idea for a simple application, if any budding app developer on here wants to try it out: just create a simple 'pre-admission screening' program that doctors can plug their patient's medical aid plan into and the procedure they need, and it will give a list of the nearest hospitals that fall within that plan's coverage. It's data, not rocket science.

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So you want the doctors to keep all the different plans on file and look them up for each patient? I wonder how many times a day that's gonna happen. And then when they change every year they gotta keep updated records on that.

You know....you could develop the app.

Don't bother responding....you are gonna whine and continue to whine.

Foxhound5366 said:

Where else in business would you apply that philosophy? When you go to a doctor you pay them money, therefore it's a business transaction and not charity.

"I don't need to know if my clients can afford me or what I'm recommending to them."

What makes it worse is in the case of a doctor, where the patient chooses a doctor because they can afford that doctor, and then the doctor goes and decides to get the patient admitted somewhere else that's needlessly expensive when much better alternatives exist (if only the doctor bothered to know about it - or have some basic reference material on-hand). Hell, I'd even have settled for the doctor saying "Ok guys, I'd recommend doing X. Can you please phone your medical aid and check if you're covered for this?" But no, the doctor just picked up the phone and started getting my wife booked in all by himself, before I stopped him.

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To be honest, the right people to have decided this, would have been the medical aid. It's their responsibility to both you and other members of the medical aid, that you get the right treatment at the right price at the right doctor. When you chose to go outside of that, you have to bear the cost. Not saying you did, just that is the way it's supposed to work.

Choose a higher tiered medical aid and stop moaning about being a cheapskate then.

Foxhound5366 said:

Like I said somewhere near the end, really?

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they are medical doctors, not accountants or financial advisors

how you pay for the treatment is a socio-political and economic issue, in countries where medical treatment is free would this be a discussion?

moreover, why would medical treatment be free in those countries? because of doctors or politicians?

yeah poorly structured response but the finance aspect of medical treatment is more a political issue than medical

Kosmik said:

To be honest, the right people to have decided this, would have been the medical aid. It's their responsibility to both you and other members of the medical aid, that you get the right treatment at the right price at the right doctor. When you chose to go outside of that, you have to bear the cost. Not saying you did, just that is the way it's supposed to work.

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Yeah it's weird why medical aids don't get more proactive. I think it's probably because it doesn't cost them money: they just pay what they pay, and you're responsible for the rest.

People here seem to have been carried away: I am not expecting doctors to know the ins and outs of all medical aids.

The LEAST they could do, however, is realise that their recommendations have a direct financial impact on their patients, and simply ask their patients: "Can you afford this? If not, I recognise that I am your partner in this and bound by the same restrictions that limit you, and I care enough about you to not live in a vacuum with no concept of money."

saturnz said:

they are medical doctors, not accountants or financial advisors

how you pay for the treatment is a socio-political and economic issue, in countries where medical treatment is free would this be a discussion?

moreover, why would medical treatment be free in those countries? because of doctors or politicians?

yeah poorly structured response but the finance aspect of medical treatment is more a political issue than medical

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Where patients are paying themselves, it's a personal issue, not political. For doctors to conveniently ignore that is irresponsible and not demonstrating an appropriate level of care and respect for their patients.

Foxhound5366 said:

Where patients are paying themselves, it's a personal issue, not political. For doctors to conveniently ignore that is irresponsible and not demonstrating an appropriate level of care and respect for their patients.

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in your opinion, my opinion differs

for them to make financial decisions pertaining to your health, they would then have to do some serious cost-benefit analysis in their minds before making a decision, CBA skills which they probably weren't taught in medical school, because well its not a finance school

basically the next time an accountant does my blood pressure and vitals, then I will start to agree with you

Doctors are required to give medical care and advice.

Medical insurance is a financial tool.

Most of the specialists we have visited the last 5 years required cash payment upfront, making it my responsibility to liaise with the medical aid. I agree with that, as it keeps my relationship with the doctor related to medical reasons.

Similarly, say I wanted to buy a new car using bank finance. Its up to the bank to decide if I can afford it and if I my credit quality is worth the risk, its not up to the car sales person. It is up to me to make sure the insurance on my car is sufficient and appropriate, not the car sales person.

Techincally you signed up for your specific insurance plan, so you should know the constraints and parameters.

Sounds like you have a bee in your bonnet. Take some initiative and ownership of tue situation.

Foxhound5366 said:

Yeah it's weird why medical aids don't get more proactive. I think it's probably because it doesn't cost them money: they just pay what they pay, and you're responsible for the rest.

People here seem to have been carried away: I am not expecting doctors to know the ins and outs of all medical aids.

The LEAST they could do, however, is realise that their recommendations have a direct financial impact on their patients, and simply ask their patients: "Can you afford this? If not, I recognise that I am your partner in this and bound by the same restrictions that limit you, and I care enough about you to not live in a vacuum with no concept of money."

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No. The onus is on you to tell the doctor. "I am on a ****ty medical aid with the following restrictions. With that in mind, could you help me another way"