Medical aid and a big bike crash - what's the process

[Skylark]

Been a few hectic crash threads on thehub, was wondering so you have a biggie, over the bars cartwheels etc, lying in the dirt leg twisted at a funny angle, 2 teeth knocked out/jaw feels wrong and you can't stop moaning, ja you wont be walking this one off.

 

So what now, I have discovery hospital plan but I'm half way up the mountain and need a Helicopter medivac thing, they can cost around R10-20k depending on the situation, I'd damn well like medical aid to cover that etc.

 

Medical bills can add up very quickly, some emergency stabilizing Meds are around R2k a shot and they may use a good few bits and pieces to make things comfortable and safe.

 

What's the process, I'm lying there things need to happen, does Medical aid cover all the rescue bills no matter the service provider etc, do you need to phone them first and ask nicely?

Edited May 9, 2014 by Skylark

[GLuvsMtb]

The higher the cover, the lower the risk is for nasty surprises. Usually an emergency admission is more or less fully covered, otherwise they would not even take you through the doors.

 

Once stabilized you should make sure that if surgery is recommended that you get it cleared by the medical aid first. Tell the docs that you are only 100% or 200% covered against med aid rates and that they should quote on the procedure beforehand.

 

Have the procedure motivated by the specialist submit for approval. With submission request that they confirm that the quoted procedure is fully covered and that any excluded items be pointed out to you. Copy your doctor in your note to the med aid, so that the doc can also assit to point out items that is not covered by med aid.

 

When the doc submits the claim, make sure that the claim is coded correctly so that there is no mix up and delay with payment to the doc after the procedure. You'd be surprised at how many docs submit incorrectly and then get frustrated when they are not paid on time.

[V12man]

www.helivac.co.za

 

Rescue bills are mostly separate from your medical aid - ask your provider what is covered and what is not.

[Tumbleweed]

Be thankful you weren't hit by a vehicle. After five days in hospital seven years back, my medical aid - Bonitas - said they wouldn't cover my bills unless I employed the use of an RAF lawyer.

[TALUS]

Trauma related admissions are seen as PMB ( prescribed minimum benefit) which means that your fund must cover all reasonable cost for treatment. Transfer to hospital is not automatically included. The problem I come across from time to time is when the fund queries "professional sport" or if the fund excludes extreme sport (MTB usually not an issue - DH can be). Read your policy and speak to your broker beforehand.

[arendoog]

A lot of MA have ER24 as their rescue sevice provider .They include ambulances and helicopter evac .If your policy include their service ,that is who you call

[Cippo]

OP, you are lucky being in the Western Cape. There are two rescue helicopters, one in Oudtshoorn and one in Cape Town. Firstly the dispatch of helicopter depends on the Provincial Health services emergency center's discretion based on your location, accessibility, injuries etc. If you get hoisted off mountain by heli and they drop you off at landing zone and you get taken to hospital by ambulance then there is only a charge for ambulance for hospital trip and treatment. Rescue services off the mountain is covered by Health Department. However if your injuries warrant you be flown to hospital immediately then the helicopter is charged for per hour or part there of flying time ( but not as a rescue service only medivac). If you are not on medical aid they will fly you to a goverment hospital emergency center. A hospital plan normally only pays for private hospital bills if you are admitted, if discharged same day you cover the emergency unit bills. A claim by helicopter team will be made to your hospital plan provider or medical aid with a motivation why you were flown to hospital. The rest of country does not have a dedicated mountain rescue service only a normal medivac service. KZN may in the future have a rescue service as in WC. At present all mountain rescues in other provinces are done with SAAF and that authorisation takes a few hours also depending on your injuries and location. If weather does not permit a helicopter rescue then a ground team will take you off mountain. If you are in WC I would advise you to contact the provincial ambulance service or SANPARKS if you are injured on mountain. A request to Netcare 911 or ER24 will first have them send a normal ambulance crew out to see if they can get you off mountain and only when they can't handle it will they call for rescue, a delay you don't want if you are injured badly and inaccessible by normal ambulance. By cellphone the provincial service is only available via 112 or SANPARKS emergency centre number in your area.

Edited May 10, 2014 by Cippo

[marko35s]

Trauma related admissions are seen as PMB ( prescribed minimum benefit) which means that your fund must cover all reasonable cost for treatment. Transfer to hospital is not automatically included. The problem I come across from time to time is when the fund queries "professional sport" or if the fund excludes extreme sport (MTB usually not an issue - DH can be). Read your policy and speak to your broker beforehand.

Unless things have changed then to the best of my knowledge MTB isnt a specified exclusion on any insurance/medical policy as yet. Add a motor however...