How gap cover helps with medical aid shortfalls

December 18, 2021

It is something that most South African families have had some experience with. The medical aid shortfalls after your medical aid plan have paid their portion, and you still owe money.

The cost of keeping yourself healthy is constantly increasing. Medical costs in South Africa are rising when compared with standard medical aid rates.

Many people have had a medical procedure done thinking that the medical aid would cover it. Suddenly they are trying to find additional money for the shortfall.

It’s not the fault of your medical aid plan, however. They only pay out according to medical aid rates. If your doctor, specialist or hospital charges more than the standard rate, then you are liable.

Unexpected medical aid shortfalls can leave you seriously short

Medical aid shortfalls

Obviously, this can come as a shock. Especially if you were hospitalised as hospital shortfalls can add up to thousands of rands very quickly.

And it’s not like you can plead that you can’t afford to pay. You have no alternative, or find your credit report suffering.

Minimising costs with medical aid shortfalls

During a medical emergency, you will not have much of a choice in how your treatment goes. However, for more routine procedures or ones that you can plan for, you have options.

Take pregnancy, you can do research upfront so that you know what kind of cost you’re in for. Speak to your doctor or obstetrician ahead of time and see whether or not you can negotiate a better rate.

In many cases, paying cash upfront to the specialist will enable you to negotiate a discounted rate. Up front payment saves the specialist the trouble of waiting for the medical aid to pay.

Talk to them about your options. Let’s say you are having a baby. Are you planning a natural birth? Are you having a C-Section? There are implications to both.

Find out what your medical aid pays

Depending on what plan and medical aid you are with, you might find that you are covered at a higher rate than standard medical aid rates.

Some medical aid plans pay as much as double or triple the rates. The reason is, of course, these plans are more expensive.

It’s also a good idea to find out what conditions are attached to your plan when it comes to payment. Do you have to go to a certain group of hospitals? Do you have to get pre-authorisation?

Finding out what the medical aid pays and what they won’t pay will save you having a fit.

Gap cover for medical aid shortfalls

Gap cover provides peace of mind and can help with those extra expenses. What happens is that your cover starts once the medical aid has paid their bit. While these policies have limitations on how much they pay out, they still provide much-needed support.

Most doctors wait until the gap cover claim settlement is paid instead of hounding you for the money straight away.

To get a FREE medical gap cover quote, just complete and send the form on this page

All info was correct at time of publishing