Why I ditched medical aid

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Cape Town - An R8 000 plus bill for five hours at a private hospital was the final straw that broke the camel's back for a Fin24 user who decided to ditch medical aid in favour of a hospital plan.

Mandy, who added her voice to the ongoing debate about high private hospital costs, said she decided to go medical aid free shortly after her daughter underwent dental surgery at a private hospital in Johannesburg.

READ: Debate on high private hospital care hots up

Hospital tariffs are set through annual negotiations between medical schemes and hospitals. These negotiated tariffs remain fixed throughout the year.

Medical schemes are relatively fragmented with just over 90 registered medical schemes serving private medical scheme members. By contrast, the private hospital sector is highly concentrated with the three largest private hospital groups accounting for approximately 80% of all hospital spend.

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Fin24 user Mandy writes:

I am not a specialist, but found this was the only way I could voice my opinion.

As far as I am concerned, this whole medical cost blame issue can only be fairly and squarely blamed on two parties: The medical aids and the hospitals.

Let me explain why I say so:

Firstly, let me say that as of the beginning of October I am proudly medical aid free. I simply refuse to be ripped off at every point by a medical aid any further. I have a hospital plan and for the rest of it I shall wing it.

READ: How to choose the right medical aid

Now back to my point.

As far as I am concerned, the doctors and specialists in my opinion are not to blame and I do not think they charge an exorbitant fee.

In July my daughter had to have her three wisdom teeth removed. The consultation with the maxillofacial surgeon was R480 – not at all outrageous for a specialist in my mind.

The cost of the three extractions came to R5 530, including VAT. The anaesthetist’s bill came to R2 100 – again not outrageous for a specialist as far as I am concerned.

The total for the specialists, therefore, was R7 630 and both accounts were paid in full by us - the maxillofacial specialist's on the day of the surgery before he would even do it and the anaesthetist's as soon as the account was emailed to us on August 6.

My daughter arrived in the ward at the private hospital in Johannesburg at exactly 13:00 and we walked out of the ward at 18:00 on the dot – a total of five hours and her bill R8 451.64.

I must just mention here, as a comparison, that we are booked into the Cabanas at Sun City the weekend of October 18 for two nights - for a family of four - and our accommodation was R7 494 and, trust me, the private hospital was no Sun City Cabanas.

My daughter's meal at the hospital consisted of some jelly and custard, a tiny yoghurt and an undrinkable fruit juice.

In the ward she was given a re-usable ice pack of probably not more than R20 and a crepe bandage, which costs R4.99 at our local Clicks.

READ: Opting for no medical aid, state hospitals

Here is the clanker: Our medical aid at the time paid the private hospital in full, no questions asked.

To date I have been reimbursed a whopping R2 081.50 for the maxillofacial surgeon and, although by their own admission they had received our submission of the anaesthetist's account on August 22, I am yet to be reimbursed the R813 that I have been told that I will be getting.

When I questioned the medical aid as to why I was being reimbursed so little – I thought I would get at least half back – I was told they only pay 100% of the scheme tariff.

When I asked how much the scheme tariff is - surely there is a rands and cents value - the lady on the other end of the line told me they won’t know until they have received the account.

This tells me medical aids pay what and if they feel like it. I think this percentage of scheme tariff garbage is a load of nonsense. Give me a rands and cents value, for example, for general practitioner we pay R250 for a consultation, for a gynaecologist we pay R500 per consultation, and so on.

Medical aids insist on IC10 codes for everything, so they must be able to set a value for each procedure.

Firstly, I think it should be law that, like the travel industry which has to disclose all costs in their advertisements, medical aids should be forced to do the same on their websites, membership booklets and so on.

Secondly, surely the hospitals should say to their patients that, if they settle their bills up front, they will be halved, but then the medical aids should agree that that amount should be reimbursed to the patient in full and the balance should be used to reimburse patients more of the specialists' bills.

I do only have one small criticism of the maxillofacial surgeon. Our original consultation was on May 20 when I was given his quotation.

I was more than willing to settle the bill right there and, if so, surely I should have been offered a sizeable discount – say 25% - because the money would have been paid and would have been in his bank account earning interest.

There again, the medical aid would have to take this into account. However, he would not accept payment, except only when I took my daughter in for the actual surgery.

I also find the irony in this whole medical cost debate is that until about 20 years ago, we didn’t have this problem. Only the very rich, those without medical aids went to private hospitals.

My eldest daughter, now aged 22, was born at our local government hospital, the cost of which was covered by medical aid.

I am also beginning to think that, like private education, we, the public, are just being fleeced and are being fed propaganda about the state of government facilities by greedy individuals (the hospitals and medical aids) which are just out to make a quick buck.

ALSO READ: Hospital cash back or medical aid

- Fin24

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Disclaimer: All articles and letters published on MyFin24 have been independently written by members of the Fin24 community. The views of users published on Fin24 are therefore their own and do not necessarily represent those of Fin24.

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