Hospitals and Specialists Exploit Medical Aid Members

    March 7, 2016

    Medical aid members are disillusioned with their lot. They feel that for the high premiums they pay each month, they are not getting the services and products they require. But if they only knew what hospitals and specialists charge they would understand. Also the medical schemes are bypass the law sometimes.

    Hospitals and Specialists – Medical Aid Members Only Knew

    • The truth is that medical schemes are not covering their members for treatments they are obliged to cover by law either. Ignorant patients simply pay up because they don’t know their rights.
    • The Prescribed Minimum Benefits (PMB) legally determines what medical aids have to cover. Patientshospitals and specialists are often unaware of how PMBs work and how medical aids try to wriggle their way out of the legal aspects around these PMBs.
    • Add to that the fact that members of medical schemes in South Africa are paying a significant amount more each year just to cover fraudulent expenditure.
    • Some medical scheme investigators say their inquiries have revealed doctors who bill several times for one procedure, hiding this kind of ‘mistake’ behind complex billing codes.

    Hospitals and Specialists – Medical Aids Play God in Determining Treatments

    There are hospitals and specialists who are exploiting medical aid members. On the other hand there are doctors who take up a lot of their time dealing with unscrupulous medical schemes.

    Doctors are finding that their doctor-patient relationships are strained and undermined because of medical schemes who actually decide what treatment the doctors can use for their patients. This is even when doctors know that an alternative treatment would be better for the patient. Many times patients could be discharged, but the treatment the medical scheme insists on means that the patients has to stay in hospital for much longer at an additional exorbitant cost.

    Recently the South African Society of Cardiovascular Intervention even suggested that medical aids are meddling with doctor-patient treatments, preventing doctors from being able to treat their patients the way they see fit.

    Hospitals and Specialists – Let Doctors Decide what is Best for Patients

    The Competition Commission has held public hearings on the serious state of private health care in South Africa. They have even invited medical aid members to let them know of their experiences where medical aids are preventing their members having access to quality health care. Society president, Dave Kettles said that even though schemes are trying to protect themselves from exploitation, they need to allow doctors to decide on the best treatment for patients.

    Hospitals and Specialists – Regulation Required for Specialists and Hospitals

    The Board of Healthcare Funders (BHF) says that the fees charged by private hospitals and specialists needs to be regulated. These fees make up the largest proportion of the medical aid members’ contributions, and medical aid members were simply facing increased contributions and shrinking benefits.

    BHF Executive Director, Dr Zokufa says that the problems stem from the fact that there are no regulations controlling what hospitals and specialists are getting up to. Take a look at births in South Africa. A shocking 72% of births are caesareans, merely done for the convenience and benefit of doctors in terms of cost and time schedules.

    The Waiting Game Continues for Answers

    The Competition Commission has initiated inquiries and public hearings will be conducted until early March and the Commission will then table its recommendations by December.

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    All info was correct at time of publishing