i am sure most of you understand how the medical aid works...i do because we have been thru a 150 000 ordeal and luck for me my wife is on the ball so we have 3 top up policies over and above the medical aid and hospital plan...but for those who dont.
we contact the medcial aid to get pre authorization and to enquire about the cover and what percentage...the medical aid advises us that they cover "100%"
make sure you understand what 100 % means... to some of us it means total cost...full payment...etc etc...unfortuntely not when it come to medical aids and doctors.
the medical aid will cover 100 % if they say they do but the problem is that the doctors charge 300 % and up...so if his bill is R300...the medical aid only covers 100 % which is R100...and you pay the balance of R200...
my glasses for example...the medical aid covers 100% but my glasses cost R3000 and that not even the lens included...i still have to select lens...the medical aid covers 100 % but only up to R1500...
my point...make sure you understand all the pros and cons of medical aids and percentages...especially if you are going in for pre authorised proceedure...you could be lying in bed think you are covered until you get the final bill...and may need to take a second bond on your house to pay for the doctors lambo he just bought because he didnt know what else to do with all the money he makes...or the depost for his island he just purchased...yeah yeah i know he has a right to rip you off because he studied for years and years....my question is then why couldnt i sue for the operation which i woke up on the operating table...because they cover their butts.
in saying that i do have some good news... my mate won a case...where he sued because his wife got pregrant after 20 years of having her tubes tired...suddenly she got pregrant...they went to court won the case and were paid out a large sum of money...to cover the kids education cost for her for the next 20 years and a few other things...so maybe there is a light at the end of the tunnel.
Reply With Quote
Did you like this article? Share it with your favourite social network.