Surviving the self-payment gap


I was standing at the front of the queue at a pharmacy, with at least 5 people behind me. My 4 children were squealing and spilling out of the trolley next to me. “That’ll be R250”, said the pharmacist.” I looked at him incredulously and swallowed… I was in my medical aid self-payment gap and had exactly R100 in my purse. “Is that for the generics?” I tried to ask quietly. “No!” boomed the pharmacist, “…the generics are out of stock!” At this point, a few people behind me were starting to tap their feet and look at their watches. And right then and there, something inside me snapped

“You studied chemistry!” I said, “You can see what the doctor is trying to achieve here. I have exactly R100 on me and a sick kid with no known allergies. Do your Pharmacology thing and make it work!” I blushed furiously but kept firm eye contact with the astonished man in the white coat. And to my great surprise, he did it. By checking what I had at home already and taking a cheaper version of the same product, he was able to come in at R98. That is R152 less than he was going to charge me. In that case, I was fortunate. My child had a basic throat infection and the antibiotics required were uncomplicated. Were it a more serious case, (or something chronic) I may have had to make another plan. 

There is nothing more frustrating than seeing those daily benefit savings dwindle, and with four kids, it’s astonishing how early in the year that can happen. But I’ve gotten savvy. In my younger years I would simply accept any bill a doctor or pharmacist gave me and pay while crying silently on the inside. Necessity has forced me to behave more outspokenly now. When I enter the GP’s office, I immediately announce when I’m in my self-payment gap and ask what rate he can give me for the consultation. There are also many doctors that offer a single fee for consultation and medicine. 

The secret is to do proper research. Very often we accept whatever we’re given because we’re too nervous or embarrassed to question them. Now I scan every medical aid chart, claim and letter. I ask for generics at every pharmacy and I tell the doctor when I already have certain medications at home. It’s not a terribly sophisticated way of doing things, but my children’s health will always come first. 

I never imagined that I’d be one of those people who fearlessly holds up the queue while demanding a cash discount. However, I have seen proper differences in my medical claims. Somehow, I’m managing to stretch that budget further. I’ve learned the value of setting aside my ego for the benefit of getting what my family needs, at a price that we can afford.

Do you have any tips for surviving the self payment gap?

Disclaimer: The views of columnists published on Parent24 are their own and therefore do not necessarily represent the views of Parent24.

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