According to Stats SA’s 2017 General Household Survey, only 17 out of every 100 South Africans have medical insurance, which is the key that opens the door to private healthcare. Across the globe, the cost of healthcare continues to drive consumers’ hands deeper into their pockets. Amidst tough economic times, however, medical aid plays an important role in providing healthcare cover and peace of mind to consumers.
Nobody plans to get sick or injured, and most people will need medical treatment at one point or another. Health insurance not only covers the costs of medical treatment but can offer a number of additional benefits and protections against unexpected, high bills from hospitals and doctors.
Damian McHugh, Head of Health Marketing at Momentum Group, says that medical aid costs and benefits are often not fully understood by policy holders. In addition to encouraging users to educate themselves on the policies of their medical scheme, McHugh advises that there are other ways that consumers can save on their medical expenses too.
“There are several practical ways for members to optimally use their benefits, thereby keeping their out-of-pocket expenses to a minimum,” says McHugh.
Prevention Remains Better than Cure
One of the ways to reduce added expenses is to make use of the preventative screening tests, such as those offered on Momentum’s Health Platform Benefit, to help prevent the development of conditions that could involve costly treatment. “For example, a member can take their children for an annual flu vaccine to prevent them from getting the flu, thereby decreasing the chances of repeat infections that may require additional consultations and medications,” explains McHugh.
Negotiate your Rate
Some doctors are willing to negotiate the rates charged in line with what a patient’s medical aid option covers. Using healthcare providers such as doctors and specialists on your medical aid option’s network will ensure the provider charges according to the rates covered on your option.
Flexibility is Fundamental
According to McHugh, medical scheme members across the country are saving up to 35% on premiums, by making use of a rapidly spreading new approach to the provider choices for members. “Momentum Health pioneered this innovation, which we have since seen duplicated across other schemes, due to its practicality and popularity,” he explains. Policies which subscribe to this structure now allow a member to tailor their provider selections to suit what is most cost effective for their specific needs. Under this more flexible option, members are able to obtain their benefits from specific chronic medication providers or hospital providers of their choice, and receive a discounted monthly premium. “The key for members is that there is no change to the value of their benefit, but they can now decide from where they receive it. This allows members to save on premiums while also eliminating costs by removing elements that they don’t need. So basically for a large reduction in premium you limit where you access some of your benefits, but the value of the benefits remain the same.”
“You can also ask your doctor or pharmacist to prescribe or dispense generic medication instead of the original medicine where possible. Be sure to make use of pharmacies on the list of designated service providers within your scheme, as they won’t ask for additional administration or dispensing fees on medication,” adds McHugh.
Query and Quote
Before undergoing a high cost treatment, ask for a quote upfront to get a full picture. If the cost outline proves outside of your financial capacity, many healthcare providers, such as dentists, offer payment arrangements. Your medical aid will usually require you to contact them for pre-authorisation before undergoing procedures in hospitals and day clinics. In doing so, members can determine whether they will be liable for any upfront co-payments and potential shortfalls in claim reimbursements.
Coping with Chronic
Being diagnosed with a chronic condition can be a particularly unsettling experience, and can also put a family under severe financial pressure. “Upon diagnosis of a chronic condition, contact your medical aid to see whether it is covered in your plan. At Momentum Health, for example, members must register the condition on our chronic medicine programme for their claims to be reimbursed from the chronic benefit. If you don’t register it, the associated costs will be covered from savings and this will deplete your savings unnecessarily. Partnering with a healthcare provider that can help you navigate the field of information is the biggest step to saving money and optimising your benefits,” says McHugh.
From his varied industry experience, and as a family man and community member, McHugh is no stranger to the physical, emotional and financial toll that can result from health issues. He explains that it is crucial for practitioners and service providers to genuinely understand an individual and their unique needs during these critical moments, whether minor or severe. “We feel strongly about this approach as it is fundamental to being able to act as a legitimate partner to people, supporting them with the knowledge and tools that will best protect and maintain their journey to success – in spite of the challenges they face,” he says.