Medical aids often hindrances

13 February 2015 - 03:03 By The Times Readers
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Increased premiums force many people to downgrade on medical aid just as their increased age makes them more likely to depend on it.
Increased premiums force many people to downgrade on medical aid just as their increased age makes them more likely to depend on it.
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Health insurers such as medical aids are financial services entities, not health-care advisers. But here in South Africa, they act as though they are.

Why should medical aids dictate how a patient (whom they have not seen) has to be managed? Or dictate what, when and how medicine is to be dispensed? In an attempt to serve the patient's best interests the doctor has to phone, and waste time on getting "authorisation", to refer or prescribe.

This means the medical aid can refuse the doctor "permission" to refer his patient to a specialist.

I am sure the actuaries inside medical aids can come up with ways to manage risk without interfering with the health professionals' clinical discretion.

Dr Kenosi Mosalakae, Houghton

I lived for many years in the UK and was a member of one of the country's leading medical insurers. It was a commonly known fact that private hospitals charged a great deal more when invoicing a medical aid scheme than they did when billing a patient who was not insured.

My insurer thus told its members not to tell health providers they were insured and to accept the bill in their personal capacity.

The paid invoice was then submitted to my insurer, who would reimburse the invoice value plus 50% of the differential between what the provider would normally charge the insurer and the amount paid.

Stephen Jeffries, Cape Town

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