What is a Hospital Co-payment?

December 18, 2021

More and more nowadays, medical schemes are encouraging their clients to use preferred providers. That benefits the medical aid in that they can control their spend. The benefit for you is that you usually do not need to make a co-payment. But what is a hospital co-payment exactly?

Going Outside the Network

What happens if you want to see a specialist outside of that network? In the past that you would have to foot the bill between what the preferred provider would have charged and the actual invoice.

Now, however, it could mean paying quite a high co-payment. That’s the answer to the question: “What is a hospital co-payment.” And, in some instances, this could work out to as much as 40% of the bill.

What is a hospital co-payment?

Essentially what the medical schemes are doing is to force you to use the preferred provider network. After all, when it comes to expensive hospital stays, who has the money for such a high co-payment.

Is This Legal?

Legally they may insist that you see the preferred provider in all but the most exceptional cases when it comes to the minimum benefits prescribed by law.

What is a Hospital Co-payment

These minimum benefits pertain to medical emergencies only and not to conditions that could, if not treated, become chronic and decrease your quality of life.

Do Your Research

You need to check the fine print in terms of who the preferred service providers are before signing up for your medical scheme. It will also pay you to find out what the co-payment is should you choose someone outside of the network.

In some cases, the doctor that you are seeing will agree to charge a reduced rate in order to minimize your out of pocket costs. This does not always work out as the medical scheme may still impose the co-payment that they choose. (Effectively this just reduces the amount that the medical scheme pays overall.)

Problems with Medication

And the co-payment may not just stop at the doctor’s fees, it may also be applied to medicine prescribed as well.

This is especially problematic when the medicine prescribed is not on the list of allowed medicines. This could mean paying for a lot of expensive medication out of pocket.

Preferred Providers to Keep Costs Down

The reasoning behind having preferred providers is to help the medical scheme keep costs down. It is meant to ensure that all clients have equal access to care. It is also intended to prevent people from using providers that charge way above standard medical aid rates.

Potential Problems for Clients

It is not always convenient to see one of the preferred providers. In some cases, this could mean travelling a fair distance in order to get assistance.

In addition, it may also mean that clients need to start seeing a new set of medical specialists – something that not everyone wants to do.

Protecting Yourself

In this instance, knowledge is definitely power. If you do your research ahead of time, you can avoid getting into a situation where a large co-payment becomes necessary.

If you are planning to visit a new doctor or get medicine from a new pharmacy, call the medical aid first and see whether or not a co-payment will apply.

Do the same before going into hospital.

And, above all, look into the possibility of buying cheap gap cover insurance from a reputable provider.

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

All info was correct at time of publishing