Medical Aid

[Captain Fastbastard Mayhem]

And the audit firms tend towards forcing the entire firm to use them so that they can tender for the audit of the big insurance companies without a threat to their independence.

Yep... like profmed, but more selective.

[Skylark]

It really depends on your circumstance and if you like risk.

 

I found that on Camaf, we dont get much day to day benefits, but having just had our first child at a private hospital and a hernia Op for him within 6 weeks, I paid the grand total of R0. Niks.

 

The total bill they covered was close to R105K, I do pay a little "more" for the check ups and doctor visits post op, but I dont need to think about selling my bike.

 

Same goes for my friend that had a major accident and was in a private ICU for close to 2 months, she paid R0. Her bill was closer to R600k after all her surgeries.

 

I think for the amount I pay, to avoid having to worry if I have a major accident that I can get treated, it is worth it.

 

Roll the dice [emoji14]

So in both those instances all the medical services were done within medical aid rates?

 

What about the other instances mentioned on this thread with large bills and R0 to pay?

 

Or did they have gap cover.

[Pure Savage]

So in both those instances all the medical services were done within medical aid rates?

 

What about the other instances mentioned on this thread with large bills and R0 to pay?

 

Or did they have gap cover.

 

Both doctors charged around 300 - 400% med rates and they covered it. I dont have gap cover, but basically if you are admitted to hospital or have a serious problemo you are covered. (I think the others on the thread would have had GAP cover)

 

But when I go to the GP and he charges me at 250% I will have to pay in the diff.

[Captain Fastbastard Mayhem]

So in both those instances all the medical services were done within medical aid rates?

 

What about the other instances mentioned on this thread with large bills and R0 to pay?

 

Or did they have gap cover.

Both cAses were PMB, thus full coverage.

 

In danger of losing life or limb = PMB. Childbirth = PMB. it really pays to have a broker who knows what they're doing...

[Stretch]

Apologise for not reading everything..but...i know a friend of a friend who fell off a ladder and now has no control of his bladder and a stuffed back as a result of waiting to be operated on in a govt hospital. All avoidable.....

[CogitoErgoSum]

I went years without a medical aid. Fortunately never needed one for myself. But there is some level of anguish when your loved one needs medical assistance...

 

In anycase, have a medical aid now. Went to casualty on saterday - my laaitie decided to split his finger with a hammer. He needed stitches. The doctor couldn't even spell the word "hammer". This was at a Netcare. His rendition "harmer"... (tried to upload photo of the guy's spelling, file to big - using tapatalk)

 

Medical aid will not ensure that you get the sharpest pencil

[Lurch the stalker]

Medical aid will not ensure that you get the sharpest pencil

I read a comment somewhere that said something along the lines of, "remember, somewhere, someone is getting treated by a doctor who came last in his class" - which is very true, we all like to believe that we have the one who graduated top of their class, but it just isn't possible.

[cfcjim]

rant/

 

I've said this before: I wish the schemes would stop calling themselves "Medical Aid".

 

They are health insurance.

 

I know it's ingrained in the populace but there's certainly no Aid in Medical Aid.

 

It is just (somewhat complex) insurance.

 

I have no axe to grind, I recently had a hip replacement, the hospital experience was smooth and the care I've received pre and post op has been excellent. (Discovery).

 

But it just galls me to see insurances allowed to call themselves something which they are clearly not.

 

/rant.

[Captain Fastbastard Mayhem]

rant/

 

I've said this before: I wish the schemes would stop calling themselves "Medical Aid".

 

They are health insurance.

 

I know it's ingrained in the populace but there's certainly no Aid in Medical Aid.

 

It is just (somewhat complex) insurance.

 

I have no axe to grind, I recently had a hip replacement, the hospital experience was smooth and the care I've received pre and post op has been excellent. (Discovery).

 

But it just galls me to see insurances allowed to call themselves something which they are clearly not.

 

/rant.

it's most probably down to the fact that they're not governed by the short / long term insurance acts - they're governed by the Council of Medical Schemes.

 

Health Insurance is that product you buy from those other providers governed by the short term insurance act, and pay you an amount per day you spend in hospital (they try to market themselves as Hospital Plans, and then have a disclaimer "Not a Medical Aid" at the end)

 

So no, it's not them, it's just what they're called. Yes, it is a type of insurance, but it's not your traditional insurance where the premium is determined by your risk factors. It's a medical aid plan... 

[ibruegge]

After 10 years of being a Discovery Coastal Saver member I still don't see the benefit of the MSA or Medical Savings Account - which is interest free, while Discovery gets miillions of ZARs from members like me to invest and get the interest. 

But otherweise, I do agree - no medical aid, big mistake. 

Edited July 15, 2015 by ibruegge

[Captain Fastbastard Mayhem]

After 10 years of being a Discovery Coastal Saver member I still don't see the benefit of the MSA or Medical Savings Account - which is interest free, while Discovery gets miillions of ZARs from members like me to invest and get the interest. 

But otherweise, I do agree - no medical aid, big mistake. 

1 thing, and 1 thing only... Investigative MRI & CT scan coverage

[RiverInTheRoad]

Hi Guys

 

I'm currently at Discovery but I have been thinking of changing to ProfMed, as there are slightly more benefits for basically the same rate. Do any of you have any experience with ProfMed? Or should I just stay at Discovery...

[Long Wheel Base]

My wife is 19weeks pregnant. We have so far been for 3 scans and they not cheap(I'm talking 4 figures per scan). We have a decent (in my mind) scheme and Ill be honest there will be no ways we could afford to use the gynae or the hospital we've chosen without medical aid. The gynae my wife uses is rated as one of the top 5 in the country and that obviously comes at a slightly higher price. She also operates out of the linkwood hospital in linksfield which is purely a maternity hospital located next to the main linksfield netcare hospital. Everything gets done there from scans to birth and post birth appointments with pediatricians.

Cut a long story short I'm much happier knowing we will be taken care of as I wouldn't be happy going to some other hospital and paying out my pocket because it's all I can afford.

 

So in my case I can't go without it.

Edited July 15, 2015 by Long Wheel Base

[Falco]

Something I've been wondering regarding hospital plans. At what stage will you get checked in and treated as admitted patient (vs out-patient)? My last trip to hospital resulted in me having to pay the entire visit cash because I was treated as an out-patient.

 

The admitted patient / out patient thing confuses the hell out of me. 

 

I have a Spectramed plan, had it for years, very happy with it. It's supposed to be a hospital plan, but it has a savings component as well.

 

My last bail off the bike, which included an ambulance trip, mri, x rays, and general patch up, was paid 100%, although I was never officially admitted to the hospital (left the same day).

 

It wasn't paid from the savings component, so it seems that certain things are covered without admission.

 

Medical aids are not easy things to understand. 

Edited July 15, 2015 by Falco

[MTBeer]

The admitted patient / out patient thing confuses the hell out of me. 

 

I have a Spectramed plan, had it for years, very happy with it. It's supposed to be a hospital plan, but it has a savings component as well.

 

My last bail off the bike, which included an ambulance trip, mri, x rays, and general patch up, was paid 100%, although I was never officially admitted to the hospital (left the same day).

 

It wasn't paid from the savings component, so it seems that certain things are covered without admission.

 

Medical aids are not easy things to understand. 

that part is deliberate, like cell phone contracts. the more obscure things are, the more they can roger the public.

[Grebel]

It is risk management at the end of the day (yours). It's been said already but I'll say it again. Rather have it and not need it than need it and not have it.

 

My father in law spent a few days at RK Kahn hospital in Chatsworth (One of KZN's better Gov Hospitals) and after visiting him there, I don't complain about my 'Medical Aid" anymore.

 

As with householders insurance, I spend as much as I can afford. Speak to the right people and you can't go wrong.

 

What you also need to keep in mind is that the onus is on the individual to figure out how to make it work best for them. Plenty different people praising and bitching about the same schemes and plans. Those that bitch didn't read the fine print or listen to the mistakes that others have made. Those that praise did. Simple as that. 

 

An example is to ask your doctor/specialist if there is an early settlement discount for out of hospital treatment/consultation. Most of them will reduce their bill if you settle on the day. You then submit the claim and get paid out of your med savings. Cash in your pocket. Your MSA lasts longer. I saved R800 off a R1700 specialist bill because I asked the question....

 

The MSA benefit is an up front savings account that is ALL available from Day 1. It is your responsibility to manage it. You don't need it and you can fund that part yourself if you really want to. I like to know that I have all of it up front... helps me sleep better at night