Image of a doctor for an article on the moneysmart community about negotiating medical bills in South Africa

Medical Aid Advice: How to Negotiate Medical Bills

04/02/2013 • • by
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Healthcare in South Africa is expensive. Whether you’re visiting a specialist – like a cardiologist for a check-up that ends up costing R800 to R1 000 per visit – or admitted to hospital for some procedure, you might not be comfortable with or simply unable to afford the price of the service. We will focus on medical bills received by someone who’s on a medical aid in this article and when and how you can negotiate these “surprise” bills. HOSPITAL ACCOUNTS Being on a medical aid in South Africa, you can be assured that the bigger part of your bills will be paid for IN-HOSPITAL procedures. On nearly all medical aid schemes, your hospital bill/account will always be paid. HOWEVER, note that if you have chosen a medical aid option which makes use of network hospitals, you must use one of these hospitals for planned procedures. If you, by choice make use of a non-network hospital, you’ll end up having to pay 20% or more of your hospital account out of your own pocket. This won’t be negotiable (as it was by choice). CO-PAYMENTS ON PROCEDURES On most medical schemes there are co-payments on certain procedures, e.g. gastroscopies and MRI/CT Scans.  These co-payments could be anything from R1 700 to around R7 600 depending on your medical scheme. Whether you’ll be able to negotiate these, in my opinion, is highly unlikely as you were made aware of these when taking out your medical aid option and could’ve planned for this type of event by saving or re-insuring (via GAP cover). These co-payments may be paid from your medical savings account or from your own pocket. These payments are payable to the hospitals and will be requested upfront before the procedure is done. SPECIALISTS AND OTHER SERVICE PROVIDER ACCOUNTS (IN-HOSPITAL) This type of account will be in the case of either in-hospital or out-of-hospital treatment from a specialist, e.g. gynaecologist, anaesthetist, peadiatrician. Specialists usually charge more than the medical aid rate. Most medical scheme options cover you at 100% of medical aid rate and a few at 200%. Say the medical aid rate is R100 for a surgeon, and the doctor is charging R300, this means that he’s charging 300% of medical aid rate and you’ll be liable for the R200. This could be negotiated down. Many specialists are willing to give you a discount if you pay cash upfront. You could also alternatively, re-insure the shortfalls via GAP cover (and you won’t personally be liable for the shortfalls). NOTE: Most medical schemes including, amongst others Discovery, Bonitas and Fedhealth, now have GP and Specialist Networks. If you make use of one of the doctors from the network, your account should always be paid in full as the scheme has arrangements with these doctors not to charge more than the agreed rate. How would you approach the doctor to negotiate a discount?
  1. Keep in mind to always be respectful when trying to negotiate an outstanding amount. The wrong attitude won't get you very far.
  2. Doctors are human too and they are (usually) very understanding if you explain your financial predicament.
  3. If possible try to negotiate the amount upfront by finding out whether the doctor charges medical aid rates or not.
  4. Whatever discount you get, pay the outstanding amount promptly. By delaying payment you will end-up paying more through interest charged by the doctors.
  Try to know what benefits you have on your medical aid option so that you’re not surprised by co-payments and shortfalls. Plan for it, either by
  1. Saving
  2. Re-insuring
  3. Making use of the network doctors and hospitals
  4. Negotiating when necessary
  For any medical aid and GAP cover queries, please feel free to contact us on nelda@medicalbenefits.co.za or call (021) 975-8324.

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