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The opinion article by Dr Brenda Kubheka generated a lot of reader response concerning how medical aid members are 'strangled' by the 'hassle factor'. Below are some of the responses we received.
An arduous exercise
I have been trying to get authorisation for the last four months for an operation which will vastly improve my quality of life. It is an arduous exercise and the doctors do not have the time to follow up on behalf of the patient. So it falls on the medical aid member to fight through the maze of trying to get hold of the right person. Emails go unanswered, and every time you are back to square one.
It appears that the aged patients are even more discriminated against.
Congratulations Dr Kubheka for taking the time to highlight this matter.
- Anonymous
Left feeling more vulnerable and sickly
I absolutely agree with Dr Kubheka have stated in her article. Medical aids make you feel even more vulnerable and sickly, especially when trying to navigate via websites and apps because there is no 'walk in' office where one can speak to a human being. I detest parting with R10k every month to a medical aid that will do everything in its power to not pay up.
- Mary Grobbelaar
Preferred Provider Negotiators limit my choice
I once was served by an optometrist and after eye test and prescription and frame choices etc., I asked the reception if we could send a quote to medical aid. She told me not to that. She said she would process the claim as she knew how to claim to maximise my benefits and she gave me a projection by her calculations of the excess payable. I insisted that we forward a quote first and was shocked when the returned response had more rejections and limitations and an excess triple the earlier prediction.
My question is that if the receptionist can calculate a package, why do the medicals aids not allow that rather than forcing us to use the Preferred Provider Negotiators (PPN) which limits my choice.
- Greg Miller
Blood is boiling
Reading this article got my blood boiling! I'm experiencing major problems with getting my money reimbursed after I had to pay cash up front for our life saving chronic scripts.
My husband is a diabetic and also on high blood pressure medication. I suffer of severe sleep apnea and I am also on chronic hypertension medication. We left for a three month visit to Namibia to escape load shedding so I can get proper sleep because I'm solely reliant on my C-pap machine.
I notified the medical aid of our travel plans before we left South Africa, but we still had to pay cash upfront when collecting our scripts. This is after we were penalised for not using a pharmacy on their preferred list. There is not a pharmacy in the whole of Namibia on that list. I was refunded only R400 out of a claim of R1600. Their reasoning is that it is an international claim therefore they deduct 20% of the amount. I am not claiming my refund in dollars or euros; the Namibian exchange rate is 1:1 with South Africa
- CD Dooling
READ | OPINION: Brenda Kubheka - Medical aid members strangled by pre-authorisation 'hassle factor'
Delays from medical aids
Medical aids schemes have rigid scientific treatment protocols aimed at saving costs for the medical aids and paying huge bonuses for monies invested by the schemes to senior management.
These protocols at best delay patient management and clinicians end up treating complications related to delayed presentation.
An example would be a patient presenting with a backache with cord compression and partial paralysis in one leg and risks of complete paralysis.
The medical aid will delay but instructing clinicians to give analgesia and bed rest whilst waiting for motivation from the clinician. In the worst case scenario they often ask clinicians to discharge the patient with the risks of paralysis to be borne by the clinicians if discharging patient without corrective surgical procedure.
This debate has many tentacles and the author only superficially covered those on the surface.
- Dr James Rametse
The threat of lawyers
The trend you are seeing became much worse during Covid. It is almost as if medical aid employees had extra time to think up hew excuses to block admissions.
As a medical practitioner who just wants to provide proper care our days are filled with nonsense like this and requests for motivation letters, which take time and keep us away from what we should be doing.
I had a similar experience with cover for a Prescribed Minimum Benefits (PMB) for my son, following a head injury. Because of the risks of Covid I opted to take him home for observation rather than admit, in agreement with the practitioner in charge. It took six months of jumping through ridiculous hoops to get his CT scan covered. Eventually the threat of lawyers had the desired effect but we should not need to resort to this.
- Anonymous
