Last month * Nosipho September landed in hospital following a flare-up of inflammatory bowel disease (IBS) that she was diagnosed with six years ago.
After spending six days in a Cape Town hospital she was finally discharged. Her medical bills left her shocked and stressed. Her medical aid had deducted all her medical savings for the co-payment she owed for the procedure while she was in hospital.
Day-to-day medical benefits cover out-of-hospital medical expenses, such as visits to the GP, dentist or optometrist, as well as medicine.
September made inquiries at her medical aid. They said her savings on her chosen plan of the scheme had been used to pay the first part of R4200 of the scope procedure. About R2500 was deducted for a sigmoidoscopy while she was in hospital.
“I was very angry and couldn’t understand why all my savings had been wiped out. First of all, I was admitted to hospital and I had authorisation so my medical aid would pay for everything from the hospital plan and not my savings. Secondly, my condition is classified as a Prescribed Minimum Benefit (PMB) - which medical schemes are required to pay in full by law.”
The Prescribed Minimum Benefits comprise a set of designated conditions and treatments that all medical schemes are legally obliged to fund in full. September has since lodged a formal complaint against her medical aid with the Council of Medical Schemes.
She is one of many looking forward to the scrapping of co-payments as announced by the Health Minister Aaron Motsoaledi as part of the amendments to the Medical Schemes Amendment Bill.
During the presentation of the National Health Insurance Bill and the Medical Schemes Amendment Bill, Motsoaledi said the first major amendment included the abolishment of co-payments.
He said patients should not be burdened with paying out of their own pocket and medical aid schemes would be required to settle bills in full.
Motsoaledi added that about two-thirds of medical schemes clients pay R2.2billion to brokers without their knowledge.
Another major shake-up was the replacement of Prescribed Minimum Benefits by comprehensive service benefits. Motsoaledi said the new bill, including the National Health Insurance Bill, will pave the way for more access to medical healthcare through NHI.
September said: “A lot of us are struggling to keep up with medical aid premiums, let alone co-payments that can cost thousands of rand. I think the use of co-payments is an unfair practice by medical schemes. Why should I pay thousands of rand for a hospital procedure that is supposed to come from my hospital plan? I hope this legislation comes into effect.”
* Not her real name.