Medical aid 'an oxymoron'
by CS
2009-06-26 14:05
Dear Editor,
So I found a lump in my breast. It wasn't very big, but to my touch it had all the characteristics of the scary type described by many a magazine article and breast cancer survivor - hard (almost coral-like) and round and movable.
Being the responsible woman I am, I immediately made an appointment, for that same day, at a specialist breast clinic. Although I was very nervous, I was also pleased with myself for being proactive about self-examination and then following through on my unwelcome discovery.
The doctors and facility were wonderful, scheduling an immediate mammogram and ultrasound. They did indeed confirm the existence of a lump, and in order to not make the situation any more stressful than it needed to be, the doctor immediately conducted a biopsy. To my relief, the results came back, two days later, as negative.
A few weeks later I dutifully submitted my bill for the experience (close to R4 000) to my well-reputed medical aid, to which I fork out over R2 500 a month. The results were as follows:
1. A little over a third of the bill will actually be counted as covered medial expenses. The rest is paid out of my savings as "higher than threshold" expense, and will be added to my "self payment gap". It's worthwhile at this point to note that I only have a savings of around R5 500 allocated to me, on one of the best schemes this medical aid has to offer, and this one bill has wiped out close to 80% of this allowance for the year.
2. The new policy is that mammograms and biopsies are no longer allowed to be performed on the same day, therefore only one will be refunded to me. The cost of these were R1 000 and R2 000 respectively. So essentially, should anyone require a biopsy for a potentially dangerous breast lump, they would be required to take TWO mornings off work, and undergo the enormous stress of the wait (which I am told is not a healthy state, and increases the probability of all sorts of diseases), and the enormous inconvenience thereof.
The message I have received loud and clear is as follows: although cancer treatment could cost the medical aid anywhere from R1m to R3m, they are more concerned with saving the pennies than ultimately the pounds. There is no reward for being proactive - just a lot of expense, as well as unnecessary inconvenience.
So yes, be proactive, live healthily and take your life back into your hands. But not too healthily, mind you, or the punishment will far outweigh the reward schemes.
CS
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