My scary medical aid story

December 18, 2021

Even though I have medical aid I was terrified when I went to the hospital to have a cyst removed from my colon.

I was scared of the hospital, the anaesthetic, the operation and the pain.

Fortunately, I am on a medical aid with 100% coverage, which was the only bright light in dark times. My medical aid gave the specialist and hospital the go-ahead for my op.

Yes, there was a lot fear in me – but it was totally misplaced, as it turned out.

The Op

The procedure went smoothly. My specialist did an amazing job.

I was in a private hospital and the staff was great.

Yes, the pain was pretty bad to start with but after two days it subsided into stiff discomfort.

After five days in the hospital, my husband took me home. I was almost sorry to say goodbye to the amazing sisters and nurses.

The Real Pain

Little did I know that the worst times lay ahead.

I started getting bills – three in total – one from the anaesthetist, another from the specialist and an especially steep one from the hospital.

In three days I got bills for R85 000.

I phoned my medical aid, in a frenzy. They calmly told me that they had covered 100% of the costs as per my medical plan.

“But why am I getting bills then?” I yelled down the phone.

Those are your co-payments, said the woman calmly.

It turned out that the medical aid had paid 100% alright — 100% of what THEY thought the whole operation should cost, and not what the actual bills amounted too. (Apparently, medical schemes have some kind of internal tariff list they work from.)

So, in short, I had experienced a radical payment shortfall as a result of the difference.

It was awful.

We had to take out a new mortgage on our house, which we had paid off ten years before, to cover these unexpected bills.

Gap Cover for Medical Aid

Too late I learned that if you are on a medical aid it is extremely unlikely that the fund will cover the costs associated with a hospital stay.

However, you can buy an inexpensive gap cover policy from a short-term insurance company to cover any payment shortfalls.

Moral of the story: if you are on a medical aid, buy medical gap cover or you could find yourself facing the pain of a hefty medical co-payment, payable from your own pocket. (I have signed up with Zestlife now to avoid medical co-payments in future.)

All info was correct at time of publishing