[Question] Summons Issues Med Aid

[DazedandConfused]

Hi I have received a Summons from a large Hospital

I joined a Medical a Hospital Plan in April 2011 and was submitted to a 3 month General Waiting Period and a 12 month period for my wife's depression

In Dec 2011 my wife OD'ed and was in serious respiratory failure and needed to be resussed on the bed, paramedics were called and they called up the local private hospital as the nearest state hospital was 20km away and the private hospital asked about my med aid details and said bring her in.

When she got to the hospital i was in a state of blind panic and the hospital phoned the med aid and they said she should be admitted as she was on the hospital plan.

the hospital gave me forms to sign but i did not know what they were and as i was from the UK i assumed they were her name and address.

She had to be resussed twice in emergency and then put on life support

The following morning i received a call from the hospital saying i owed them £10 000 and that if i do not pay my wife will be discharged, but the doc in ICU said the med aid would pay until she is stable.. I told the hospital that she had a hospital plan but the hospital said the med aid rejected the request and were not paying

The following day as soon as the tubes came out of her throat she discharged herself.

Then I received around R35 000.00 of bills and i kept saying med aid will cover.. and they re submitted to med aid and they kept rejecting saying that the reason was that the cause was depression and that she was in a waiting period.

There is a pamphlet from the med aid that says quite clearly that the med aid will pay in a life threatening emergency until you are stabilised EVEN IF YOU ARE IN A WAITING PERIOD.


In sept 2011 I laid a complaint with the council of med aid and am still waiting a response

But in the mean time the largest creditor the Hospital has issued a summons, they did wait 6 months but now have issued.. I am unemployed and so is my wife and i do not have R22 000 to pay them

I am still waiting for the council before i can sue the med aid for breach of promise / false advertising etc..

What can I do in the mean time to delay the summons further?

[DazedandConfused]

Is this in the right forum ?

[Dave A]

Is this in the right forum ?

Good question. I've moved it to the general business forum, although the NCA forum was also a possibility. Could even end up in the whistleblower section if the lack of response from the council for medical aid is identified as a significant issue, but I simply do not know enough about the subject to make that call.

I hope someone here can give you some useful insight.

[DazedandConfused]

All i need to do is know what I can do about the summons .. what happens if i contest it?

[DazedandConfused]

All i need to do is know what I can do about the summons .. what happens if i contest it?

Sorry I have had a response from the Council.. they are looking at the 12 month waiting period and whether the admittance is part of thiis, they have alos push it up to somewhere else for further investigation and this was 2 months ago.. They are not even looking at the confusing statements from the med aid

[Dave A]

Sorry I have had a response from the Council.. they are looking at the 12 month waiting period and whether the admittance is part of thiis, they have alos push it up to somewhere else for further investigation and this was 2 months ago..

Advise the Council that you have received summons and the matter is now urgent.
I also recommend you seek legal representation. A poor alternative is to read this thread and perhaps post your dilemma there - I see Vanash is responding to particular scenarios...

[Citizen X]

Good afternoon DazedandConfused,

I would like to impress upon you that your matter is indeed heart wrenching! I’m terribly sorry that both you and your wife had to endure so much at the hands of a hospital and a medical aid. My response may be long winded, but it’s really necessary.

My advice is not meant to substitute for the services of an attorney. I’m hoping that the council will resolve this matter in your favour!

1. Firstly, for the sake of clarity, let’s separate the parties for now. The Hospital is the service provider and is regulated by a) The National Health Act 61 of 2003[1] and b) The Health Professionals Act 56 of 1974.[2] Disciplinary control is meted out by the Health Professionals Council of South Africa(HPCSA) alternatively a court of law for delict[3]. The Medical Aid is regulated by the Medical Schemes Act 131 of 1998.[4](The versions that I have, definitely have the latest amendments as they are downloaded from Sabinet. I’m not entirely certain about the url’s I include here. So at this stage the hospital and not the medical aid is the plaintiff and you are the defendant;
2. The Plaintiff sued out summons, due to the monetary value , the Magistrates Court has jurisdiction. Upon receiving the summons( which I suspect is an ordinary summons), you are called upon to enter a notice of intention to defend the action. You are given a specified period of time within which to do so. Ideally you have 3 copies, one you serve on the plaintiff(their attorney), get them to stamp your copy or sign your copy, then file the second copy to the clerk of courts of the relevant Magistrates court. Also get the clerk of courts to stamp your copy.;
3. If as I suspect, this is an ordinary summons, then, at a later stage, the Plaintiff will send you a notice to file your plea on merits. It is here where your challenge lies, as you will have to plead paragraph by paragraph to every paragraph included in the Plaintiff’s particulars of claim. A problem is that the patient remains liable for the bill and not the medical aid; The fact that you signed indemnity forms which would have placed medical costs responsibility upon you without reading it will unfortunately not be a valid defence, as at today’s date the latest case-law on the law of contract and medical law strongly suggest that the admission clerk was not obliged to point out any clause to you and that by signing it you deemed to have read it.
I don’t know if ‘section 27,’ can assist you, it won’t harm to contact them. This is their website:
http://www.section27.org.za/




The following is off topic but I feel that it belongs here(This has no bearing on your case!!!)!

4.Emergency Medical Treatment: The legal position
We may all have conceptions of what is classified as emergency medical treatment and perhaps more importantly how long should such emergency medical treatment be administered when a patient doesn’t pay for whatever reason.
Section 27(3) of the Constitution of 1996 provides that “No one may be refused emergency medical treatment.”[5]
Section 5 of the National Health Care Act[6] is entitled “ Emergency Treatment” and reads as follows:
“A health care provider, health worker or health establishment may not refuse a person emergency medical treatment.”
So we come to the vital question again: What is emergency medical treatment?


The Constitutional Court decided just such a question In Soobramoney v Minister of Health, KwaZulu-Natal 1998 (1) SA 765 (CC).[7] In this case Mr Soobramaney was a very ill man, he was unemployed at this time and was suffering from chronic kidney failure and needed dialysis to prolong his life. The hospital refused him admittance on the basis that his was a chronic condition. The CC was of the opinion that ‘emergency medical treatment,’ does not include on-going treatment of a chronic illness.

At para 51 Sachs J stated “The special attention given by section 27(3) to non-refusal of emergency medical treatment relates to the particular sense of shock to our notions of human solidarity occasioned by the turning away from hospital of people battered and bleeding or of those who fall victim to sudden and unexpected collapse. It provides reassurance to all members of society that accident and emergency departments will be available to deal with the unforeseeable catastrophes which could befall any person, anywhere and at any time.The values protected by section 27(3) would, accordingly, be undermined rather than reinforced by any unwarranted conflation of emergency and non-emergency treatment such as that argued for by the appellant.”

Upon studying this case my layman’s conclusion is that emergency medical treatment is meant to resuscitate, alternatively emergency medical treatment to save a life. This is what cannot be refused by any health care provider, but once you are alive, there is no longer any emergency, this doesn’t mean that you may not require more treatment but just that the emergency phase is over! The key question arises when a patient can no longer pay for treatment, what takes place then? From what I deduce as long as the hospital can state that they resuscitated the patient or stabilised the patient, they would have met the requirement of section 27. They could then discharge the patient or transfer the patient

---

[1] Vide: National Health Act: http://www.polity.org.za/article/nat...-no-61-of-2003. Accessed 28 March 2013

[2] Vide: Health Professionals Act: http://www.hpcsa.co.za/downloads/hea...ct_56_1974.pdf. Accessed 28 March 2013

[3] Vide: HPCSA: http://www.hpcsa.co.za/

[4]Vide: Medical Schemes Act: http://www.doh.gov.za/docs/legislati...act98-131.html. Accessed 28 March 2013




[5]Vide: Constitution: http://www.info.gov.za/documents/constitution/1996/a108-96.pdf. Accessed 28 March 2013



[6] Supra n 1

[7] Vide: Soobramoney v Minister of Health:http://www.saflii.org.za/za/cases/ZACC/1997/17.pdf. Accessed 28 March 2013

[DazedandConfused]

WOW thanks

[Citizen X]

WOW thanks

Can you advise as to what practical steps you have already taken with the summons and if it was an ordinary summons and combined summons. Advise when you received it and what deadlines in terms of number of days it grants you

[DazedandConfused]

I received the summons and went to the hospital and they said that they will make a payment arrangement with me... until the case is sorted out with the Council... the hospital will not apply for judgement without informing me first.. they said that if I put in an action to defend that this will start a horrible ball rolling with their lawyers and that it will be out of their hands

But if I start paying it then shows that I admit that i am personally responsible for the bill

I still have outstanding account for the doctors, pathology, anaesthetist etc etc