Our Blog
Does anyone choose their anaesthetist?
One of the tools used by medical aids to manage the costs of Prescribed Minimum Benefits (PMBs) is to contract with doctors to form a network of doctors. In exchange for a higher fee from the medical aid and, perhaps, other benefits like direct or more rapid...
Cancer patients now have a better chance of getting their treatment fully funded by their medical aid
A number of Prescribed Minimum Benefits (PMBs) do not specify the treatment that would be required for the condition. This has resulted in medical aids taking different approaches to the funding of the treatment for these conditions. Some decline to fund...
Will regulating prices control total costs in South African private healthcare?
On the 11th of September 2020, the Competition Commission issued a notice to stakeholders on the implementation of the outcome of the Health Market Inquiry. A key aspect of the notice was to inform stakeholders that a process has been initiated which will, ultimately,...
The bill for laboratory tests is often unpaid by your medical aid – here’s potentially why.
Many medical aid members find that, although their doctor and other bills are paid (or at least part paid) by their medical aid, the pathology bills are not paid at all. This is particularly puzzling in instances where the pathology tests were part of confirming...
Why do medical aids short pay?
When medical aids don’t pay a claim in full it can really hurt financially and is very frustrating for the member. The rules and regulations, benefit design, and hoops that the medical aid asks the member to through are confusing at the best of times. Sometimes...
Will your medical aid pay for your COVID-19 testing and treatment?
The answer to this question changed on Friday the 22nd of May 2020 when the Minister of Health published the required regulations to make COVID19 a Prescribed Minimum Benefit (PMB). However, payment does still to some extent, depend on which medical aid you are...
Why do some doctors bump up their fees when the patient is insured?
There are as many views on whether doctors charge too much for their services as there are patients that visit doctors. Medical aids in South Africa set their rates for services by doctors and pay that as a benefit to contribute towards the cost of healthcare, no...
Frustrating non-payment of PMBs
Some years ago I travelled around South Africa and visited members of Medical Schemes who were weekly paid workers and members of a trade union. I came across a number of people who, as members of a Medical Scheme, had been hospitalised (or more commonly a family...
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