Page 1 of 4 123 ... LastLast
Results 1 to 10 of 36

Thread: Medical Aid. Do they really care??

Hybrid View

Previous Post Previous Post   Next Post Next Post
  1. #1
    Email problem
    Join Date
    Jan 2015
    Location
    Cape Town
    Posts
    11
    Thanks
    2
    Thanked 0 Times in 0 Posts

    Medical Aid. Do they really care??

    Focus on their own needs at the core of Momentum Health in 2015

    Medical aids of today has come a long way from the old days where they just paid for your medical expenses. Today there is a huge focus on healthy living and preventative behaviour that all gets linked to fancy rewards schemes to motivate the members to engage in healthy living practises. They advise you to go for pre-screening for just about every condition possible from regular blood pressure tests to prostate check-ups and a whole long list more.

    It came as a huge shock to me then, when I requested admission to a rehabilitation facility for a long standing drug addiction, that they declined the authorisation.

    I should start by giving all the facts. I use to work in the financial industry and was a member of Bankmed for about 9 years up until 2010. At that time I lost my job as a result of my addiction. Oh, the work never new about my addiction, but my quality of work had deteriorated to a point where I was a liability to the company and hence they let me go. Then around middle of 2014 my partner got very ill and had to stay in hospital for more than a month and I realized that we can’t be without a medical aid started looking for a new medical aid. Due to the fact that Bankmed is a subsidiary of Momentum Health I decided to join them.

    All the contracts were signed in middle September 2014 and the first premium deducted on 1 October 2014. Then during the festive season I engaged in very risky sexual behaviour whilst I was under the influence and had a HIV scare. To my great relief the second test came back negative, but it made me reflect on my live and my 15 year addiction to crystal meth. I decided that I need to make a change as my life was slipping away slowly whilst I was high every single day.
    I immediately started looking into treatment facilities for drug addiction and after long deliberation decided on a facility that had a good reputation and was reasonably priced. The total cost would fall well within my benefit that Momentum Health said I have. To my great surprise the clinic phoned me this morning to advise me that the authorisation request has been rejected. The reason was because I have not been a member of the medical aid for 12 months.

    I immediately got onto the phone to speak to Momentum because surely this is a mistake or misunderstanding of some sort. The call centre referred me to Ms Saksha who according to them is the person who deals with this type of authorization. Explaining to her my long history of addiction (15 years) and my close call of last year that lead to the decision to kick this destructive habit, I was shocked to just get a cold shoulder on the other side of the phone. I was told that the condition was pre-existing and if I had declared it on the application they would have excluded it for 12 months so they will not authorize it before October this year.

    I was totally blown away. So Momentum would rather let me risk my life for another 7 months taking this destructive drug than approve a benefit that is part of the policy I am paying for every month? What has all of a sudden happened to healthy living and preventative behaviour? How much does Momentum really care about their members when “company policy” as she put it take precedence of somebodies health? Are all these healthy living schemes got anything to do with the members or is it all just there to try and increase the medical aid’s profits?

    According to a Media Launch in September 2014
    Focus on client needs at the core of Momentum Health in 2015
    I beg to differ!

  2. #2
    Suspended
    Join Date
    Mar 2013
    Location
    Had enough
    Posts
    3,358
    Thanks
    114
    Thanked 213 Times in 201 Posts
    Just a question. Yes good for you for kicking the habit, but medical aids are business people like a lot of us. I am on a medical aid - why should I pay a higher premium because some people (like yourself maybe) that is trying to kick a self induced habit and now needs to stop ? Because if everyone is allowed to just do anything and then claim from the medical aid our premiums would go up and up and up ..... Just my thought and answer to your question above and I think I have a valid point as much as you think you have a valid point.

    PS somewhere along the line someone will pay for it and be penalised - why should it not be you ?

  3. #3
    Email problem
    Join Date
    Jan 2015
    Location
    Cape Town
    Posts
    11
    Thanks
    2
    Thanked 0 Times in 0 Posts
    Quote Originally Posted by HR Solutions View Post
    Because if everyone is allowed to just do anything and then claim from the medical aid our premiums would go up and up and up .....

    PS somewhere along the line someone will pay for it and be penalised - why should it not be you ?
    Everyone is not just doing anything, it is part of the benefits that I pay for monthly same as you are paying for yours. Do I tell you what I think is something valid that you are allowed to claim for? No. It's not about if Momentum will pay, they will but will only do it in 7 months time. Someone is paying for it, me on a monthly basis....

  4. #4
    Full Member
    Join Date
    Mar 2013
    Location
    South Africa
    Posts
    72
    Thanks
    0
    Thanked 5 Times in 5 Posts
    I could not agree with HR more ..... and then there is the little matter of non disclosure on the application form.

  5. #5
    Email problem
    Join Date
    Jan 2015
    Location
    Cape Town
    Posts
    11
    Thanks
    2
    Thanked 0 Times in 0 Posts
    Quote Originally Posted by Richard S View Post
    I could not agree with HR more ..... and then there is the little matter of non disclosure on the application form.
    It's got nothing to do with non disclosure. I was never asked if I had an addiction problem and besides, when I joined up rehab was never even on the cards. It just wasn't something that I thought I would ever consider at the time.

  6. #6
    Diamond Member Justloadit's Avatar
    Join Date
    Nov 2010
    Location
    Johannesburg
    Posts
    3,479
    Thanks
    134
    Thanked 695 Times in 593 Posts
    Blog Entries
    1
    Another reason for the 12month waiting period for expensive medical treatments, is to stop people from not being on medical aid, and when they need the expensive treatment, join the medical aid an claim for this treatment, at the expense of the other long term members.

    So effectively the medical aid is also a type of long term savings for that future expensive treatment.
    Victor - Knowledge is a blessing or a curse, your current circumstances make you decide!
    Solar pumping, Solar Geyser & Solar Security lighting solutions - www.microsolve.co.za

  7. #7
    Email problem
    Join Date
    Jan 2015
    Location
    Cape Town
    Posts
    11
    Thanks
    2
    Thanked 0 Times in 0 Posts
    Quote Originally Posted by Justloadit View Post
    Another reason for the 12month waiting period for expensive medical treatments, is to stop people from not being on medical aid, and when they need the expensive treatment, join the medical aid an claim for this treatment, at the expense of the other long term members.

    So effectively the medical aid is also a type of long term savings for that future expensive treatment.
    I fully understand that, but it is not as if I have never had medical aid. I belonged to them for 9 years previously without any major medical claim. And the cost of the treatment would only be R 25 000.00. We are not talking about millions here. Yes, it is a lot of money, but taken that I pay my premium every month and it is part of the benefit I think it is within reason.

  8. #8
    New Member
    Join Date
    Jan 2015
    Location
    South Africa
    Posts
    1
    Thanks
    0
    Thanked 2 Times in 1 Post

    Wow

    I have the same problem. I joined my scheme, and now they won't pay for my gastric banding to lose weight. They didn't ask I am fat. It's not my fault I'm addicted to cake. They also won't pay for my lasik for my eyes, I can't see properly even with glasses....how am I supposed to choose healthier foods if I can't see- everytime I buy something, thinking it's low GI- it tends to turn out to be cake. When I reach for an apple, I can't see the difference, and sometimes grab a cupcake. I've been paying premiums for almost one month now, and they don't want to help me out.

  9. Thank given for this post:

    HR Solutions (26-Jan-15), wynn (27-Jan-15)

  10. #9
    Diamond Member
    Join Date
    Mar 2010
    Location
    Cape Town
    Posts
    6,329
    Thanks
    426
    Thanked 978 Times in 795 Posts
    Quote Originally Posted by cookie View Post
    I have the same problem. I joined my scheme, and now they won't pay for my gastric banding to lose weight. They didn't ask I am fat. It's not my fault I'm addicted to cake. They also won't pay for my lasik for my eyes, I can't see properly even with glasses....how am I supposed to choose healthier foods if I can't see- everytime I buy something, thinking it's low GI- it tends to turn out to be cake. When I reach for an apple, I can't see the difference, and sometimes grab a cupcake. I've been paying premiums for almost one month now, and they don't want to help me out.
    wha ha ha ha!

  11. #10
    Suspended
    Join Date
    Mar 2013
    Location
    Had enough
    Posts
    3,358
    Thanks
    114
    Thanked 213 Times in 201 Posts
    Lol .....

Page 1 of 4 123 ... LastLast

Similar Threads

  1. Replies: 3
    Last Post: 28-Aug-13, 09:30 PM
  2. [Question] neglegence in sending medical bill to medical aid on time, what do we do?
    By polar101 in forum National Credit Act Forum
    Replies: 3
    Last Post: 30-Apr-13, 03:47 PM
  3. Replies: 0
    Last Post: 04-Oct-12, 09:05 AM
  4. Medical Insurance as opposed to a Registered Medical Aid
    By LotteTorkilson in forum Tax Forum
    Replies: 7
    Last Post: 01-Oct-12, 08:04 AM
  5. Question on U-care...
    By Peter Princeton in forum MLM Industry Forum
    Replies: 4
    Last Post: 08-Aug-11, 09:04 AM

Tags for this Thread

Did you like this article? Share it with your favourite social network.

Did you like this article? Share it with your favourite social network.

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •