A recent trip to a hospital emergency unit cost me nearly R2,000 more in blood tests because no-one told me I could pay cash and claim from my medical aid. The pathologist claims they provide a cash option but the hospital staff deny it’s their responsibility to inform patients. They say patients need to inquire about the cost of treatment and arrange for payment, quoting the Patient’s Rights Charter of South Africa.
How much money I could have saved paying cash
To understand the numbers, a pathology claim of R4,730 was submitted to my medical aid. If I paid cash, the same battery of tests would have cost R2,885. The pathologist has confirmed that their practice is happy to do these tests at a vastly reduced rate if payment is in cash. They claim the medical aid sets the rates they are paid, when they submit the claim.
First time I saw the cost was in the medical aid claim
The first time I was aware of the cost was when I received the claim status from my medical aid. At no point did I approve the cost or even confirm that the treatment was given. As an aside, I had another experience a few years back where a dental practice charged for services they never rendered, and the medical aid paid them. I fought the issue, and the claim was reversed. But that’s another story for another day.
We need to take ownership of our medical costs
It’s easy to lay the responsibility of costs at the patient’s door, but in reality, the first thing one is asked when entering a medical facility is “Are you on medical aid?” and it’s then assumed that if you are, the claim will go through to your medical aid.
It’s a valuable lesson to take ownership of one’s medical costs, but the process seems far too slick and easy for medical facilities to charge what they want to and for medical aids to simply pay.
In a time where medical costs are under scrutiny and many medical aid members are on savings plans, I find this stance shocking.
Medical aid vs. private rates is “confidential” information
The medical facility also refuses to give me their private vs. medical aid rates, stating this is confidential information. This is a WTF moment for me as patients and medical aid members pay for this. Different medical aids also pay different rates to the same medical provider.
I’m not letting this story go and am pushing for more answers. This smells of collusion.
