Although she had a good medical plan, the surgeon charged well above its rate – and she’s one of millions of South Africans who’ve experienced the same crisis.
Each medical scheme can determine its own rate of cover and pays claims based on this rate. Doctors independently determine their own rates, so what your medical scheme pays doesn’t necessarily tie up with what the doctor charges. As specialist fees continue to increase, so the gap between what the medical scheme covers and the specialist charges will widen further.
Combine this with increases in the amount of elective procedures that now require co-payments and you’re almost ertain to receive a heftu bill after undergoing a medical procedure.
If you don’t want to be caught by surprise, then you could upgrade to a more comprehensive medical scheme plan – but this comes at a significantly higher cost. For example, for a family of four to increase cover from a saver plan to a comprehensive plan costs at least R2 000 extra per month.
A far more cost-effective option is gap cover, an insurance that meets the shortfall between your medical bill and the payment made by your medical scheme. You can get a fairly comprehensive medical gap cover insurance for around R300 per month for the whole family.
What you need to be aware of is that gap cover only pays for specialist bills in-hospital and doesn’t cover an out-of-hospital visit to a specialist, for example.
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