Medical aid schemes ‘cut costs to clients’ detriment’

Doctors are warning that the dictatorial approach of medical aid schemes to cut costs could threaten the benefits and quality care that members pay for.

This comes after the major medical aid schemes announced their price increases for 2019, with Discovery increasing by 9.2% and Momentum by 10.7%.

Specialist physician Dr Adri Kok and her colleagues held a roundtable discussion on Thursday to express their dissatisfaction with medical aid schemes across the board and to warn the public about the implications of not fully understanding the medical packages they contribute towards.

Kok said medical aid schemes were becoming increasingly focused on cutting costs and finding cheaper ways to assist members. She said they did this by creating limitations in their medical packages, preventing clients from receiving their full benefits and quality healthcare.

While the prices of their medical aids increased, many members did not fully understand what they were paying for and some downgraded because they could no longer afford to pay.

She said many people who were not aware of what their packages included ended up in situations where they were unable to pay for all their medical needs because their medical aid schemes refused to pay for treatment not included in their package.

Kok said: “There has been a dictatorial sort of approach taken by the medical aid schemes about what will and will not happen. For example, a case manager who has the relevant qualifications can come in and say that you can’t admit a patient without conducting the relevant examinations.

“In this case, if you insist on admitting the patient, the patient will pay for the costs themselves and in most cases, they are unable to afford it.”

She said while the medical aids chased cheaper deals, cutting costs would be to the detriment of the patients. The focus should be on efficiency rather than on cheaper services.

She said there were patients who were dying because of medical aids’ limitations.

“Patients need to understand what we (as doctors) are worried about. I believe if patients understand the guidelines and how to interrogate their accounts and what to do, they will have the insight to know how to fight this.”

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