Reading through your monthly medical aid remittance can often be confusing with columns of codes that makes little sense to the average person. These tariff codes are a standardised means by which medical aids can communicate with each other, healthcare practitioners and other service providers. It removes the need to describe each consultation, medication or procedure in English or any other language as these codes are universal among all medical aids in South Africa. Although most remittance advices have a description of the service rendered, medication prescribed or procedure conducted, it is important for the medical aid member to understand the relevance of these codes and how it may affect their medical costs.
Medical aids classify certain procedures as non-essential – meaning that it is not of a life-threatening nature should it not be conducted. LASIK eye surgery and cosmetic surgery are considered as non-essential service. While most medical aids in South Africa will partly cover the costs of the LASIK procedure, almost all medical aids do not pay for cosmetic surgery.
The past two years (2008, 2009) have seen a few small medical aids in South Africa becoming insolvent and filing for dissolution before the year end. This has left their members in the lurch, despite promises to pay outstanding medical bills to doctors and other practitioners. While medical aid members may claim to be ignorant, the warning signs should be evident to any attentive member. In these cases, it is best to switch over to a more stable medical aid rather than waiting for your medical aid to go bust.
Providing medical aid cover for your family is an essential undertaking that does not come cheap. Medical aids in South Africa can be pricey to say the least but without medical cover, you will be at the mercy of the understaffed and overworked public health sector. Family medical aid usually involves the main member along with an adult dependent and one or more child dependents. At times other dependents, like a grandparent, may also be added to the medical aid cover.
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Medical aids in South Africa are essentially a health insurance. In the event that you need to access medical services, your medical aid will ensure that you have financial cover to meet your bills. Many practitioners, pharmacies and all private hospitals claim directly from your medical aid so as not to inconvenience you with up from cash payments.
Nevertheless the contract exists between you and your medical aid and any provider who is contracted into a medical and dealing directly with your scheme is actually doing you a favour.
Being a member of a medical aid does not guarantee that all your medical bills will be paid directly by your scheme. Certain medical aid restrictions and providers contracted out of medical means that you have to pay cash for these services. In most instances, your medical aid will then reimburse you directly for these costs.
If you have paid cash for any medical service, ensure that you get a statement and a receipt from the provider. While the receipt verifies that cash was exchanged for the service or product, the provider’s statement will contain all the necessary details for your medical aid to process the claim. In this instance, you medical aid will then pay you directly – either by check or via EFT into your bank account.
