Disclaimer: The views and opinions expressed are MY own. This is NOT a sponsored post. I am in NO way referring to any one medical aid. The aim of my post is to shed some light on the terminology referred to by medical aids and/or medical professionals and to hopefully help YOU avoid going through unnecessary drama in case you have to deal with your medical aid.

With a new year brings a healthy new balance of medical aid funds ­čÖé If you have kids, you will understand how towards the end of every year you use your funds cautiously, to ensure that you are covered right up until 31 December!

Medical Aids

We JUST can’t live without it. Well, my family can’t. We have two kids. Albeit, they are NOT sickly/unhealthy, we have had our fair share or trips to the Emergency Room and being admitted to hospital. We have a comprehensive plan that cost quite a bit every month. It is becoming more prevalent that people are seeking out only hospital plans as opposed to a full comprehensive plan.

For me, the pro’s outweigh the con’s when it comes to a full comprehensive plan. I heard people saying, “save the monthly premium that you would give to the medical aid”. In my experience, even if we saved up a full year’s premiums, we would still NOT have enough money to cover everything that the medical does. Also, none of the people who say this actually have a savings plan as they advise…

I get that life happens and you might save the first month or three, but┬á then other expenses creep in and you suddenly use “that saving” towards something else. And before you know it, the year is gone. What have you actually saved?

Medical aid is my family’s perk!

What your medical aid doesn’t tell you

Do you know what a PMB is? PMB=Prescribed minimum benefit. That means that YOU are entitled to receive the necessary medical attention and the medical aid SHOULD pay for it as long as your treating doctor deems the diagnosis as a PMB. Every medical aid has a PMB list. This list should be readily available to members on their websites or sent to members upon request. Do you know what YOU are eligible for under PMBs? READ THE FINE PRINT!

Some doctors will motivate a diagnosis and others won’t. The gist of the matter is that medical aids are slightly more inclined to pay for your expenses should your doctor motivate certain procedures and/or medication.

Co-payments for medical procedures

Do you just pay or do you question WHY you have a co-payment? Fact is that I have been told I needed to pay and then in fact it was NOT the case. Refer back to getting your doctor to motivate a procedure and/or medication. Do not just pay the co-payment. Question them. You are entitled to an explanation as to why this expense is your responsibility. You might be pleasantly surprised at the outcome.

Another situation that has surfaced is that so many doctors are contracted out and require a payment upfront from the patient or patient’s parent/guardian. I get that some medical aids will pay only the bare minimum and I also get that some doctors charge exorbitant fees. BUT can doctors and medical aids not reach a compromise? Not everyone is by means to fork out cash upfront, that’s why you pay for medical aid.

I also understand that as a patient, you are the customer, and it is your right to shop around. But what do you do when doctor X is the only doctor closest to you that can do whatever procedure is required BUT they charge 300 sometimes 500 % of medical aid rates?

 

This discussion on medical aids can go on to infinity and beyond. Hence, why I said that this is only PART 1. I know that I won’t change the situation with just one post BUT I do think that we, the customers, CAN and WILL make a difference is we SPEAK UP!

Do you have a medical aid?

Do they cover everything without you having to donate an organ?

Spirited Mama

x

P.S. Happy 2019 folks!