Co-payments. Self-payment gaps. Out-of-pocket expenses. It may feel like you need to empty your savings account to stay healthy.
You’re not alone. Medical aid members spend over R65-million rand a year on our medical schemes. “Many women assume these costs are non-negotiable,” says Michelle Katz, author of 101 Health Insurance Tips (LifeTips). But it’s easy to save hundreds on your bills each year by speaking to your doctor or choosing another medical aid plan, she says. Here, learn why you’re paying too much — and how you can put that money back in your pocket.
1. CHOOSE A PLAN CAREFULLY
When it comes time to renew your medical aid this year, don’t blindly tick the box next to your current policy. “Re-evaluate your plan annually to ensure it meets your current needs,” says Kimberly Lankford, author of The Insurance Maze (Kaplan Business). The first question you should ask is whether you have a favourite doctor or a medical condition that requires a specialist’s care. If you answered yes to either, your best bet may be one of the pricier preferred-provider plans, which gives you the freedom to visit any doctor, says Lankford. If not, you may want to consider a hospital-only plan, and start your own savings account for incidental consultations, medicines and emergencies.
A medical aid-contracted doctor will charge a set fee negotiated and agreed by them and the medical scheme. The account is settled directly, and you pay nothing at your visit. A doctor not contracted to medical aid can charge any fee he chooses, and you’ll need to settle the account at your consultation and then claim back a portion.
When choosing a scheme, also consider “your prescriptions, regular care needs and mental health and vision expenses,” says Lankford. “Also consider if you’re planning on becoming pregnant within the year, because plans cover those costs differently.”
2. QUESTION YOUR TESTS
“Doctors aren’t necessarily aware of what screens and exams are covered by your medical aid,” says Katz. To avoid pricey surprises, bring a list of approved tests to your first appointment with a new physician. Also check with your scheme before you schedule any treatments or lab tests, such as pathology work, X-rays, MRIs, and breast ultrasounds; you may need to get written or verbal approval beforehand. Record the name of the person you spoke to, as well as the date and time of the call,” says Lankford. “A paper trail is crucial if there are any questions or disputes later on.”
A recent change that affects us as women, is the way pap smears are done. Many gynaes now prefer to conduct a liquid-based cytology test to screen for cancer of the cervix. Pathology laboratories say this test offers a 65 percent improvement in early detection, but some medical aids, including Discovery Health, do not pay for it. You may not be aware of your doctor’s preference until you get the bill, so ask upfront.
3. BE PREPARED TO BARGAIN
If you’re paying your bills out of pocket, don’t be shy or embarrassed to ask your doctor for a discount. “Explain your situation,” says Katz. “Say, ‘You’re not in my network, but I wouldn’t trust anyone else to handle this. Is there any way you can adjust your fee for me ‘ The key is to establish a personal relationship with your doctor and the staff,” says Katz, who recommends arriving on time for your appointments and always expressing your appreciation.
Reader Catherine Giles adds: “When my mother, a pensioner, needed an expensive knee replacement operation, we negotiated with her surgeon that he charge her medical aid rates for the surgery even though he’s contracted out of medical aid. His receptionist said he often did this for pensioners because the shortfall between his usual fee and what medical aid was willing to pay was too great for most pensioners to afford. In the end it saved us around R6000.”
4. KNOW WHAT TO DO IN AN EMERGENCY
When a crisis occurs, hospital and doctors’ fees are probably the last thing you’re thinking about. That’s why it’s crucial to review your policy in advance. “Check to see if you need pre-approval before going to the emergency room and note which hospitals in your area are part of your scheme or plan’s network,” says Lankford.
You’ll protect yourself from an unexpected bill. Internationally, medical aid companies deny 20 percent of all emergency care payment requests that require prior authorisation, according to a recent study published in the Annals of Emergency Medicine. “If it’s an emergency, of course don’t hesitate to call an ambulance,” says Lankford. But for non-life-threatening situations, ask a friend or family member to drive you to hospital.
5. REVIEW YOUR HOSPITAL BILL
Most women scrutinise their credit card statements every month, yet very few of us even glance at our hospital invoices. But we should. Experts estimate up to 90 percent of hospital bills contain errors. Before you are discharged, request an itemised bill. “Each treatment you receive is assigned a numerical (NAPPI) code,” explains Katz. So somebody accidentally typing in the wrong code could mean a difference of hundreds or even thousands of rands to you. Before leaving, scan your bill for any unusual charges. Then, at your next appointment, ask your doctor or someone on his staff to go over anything you don’t recognise.
6. PAY WITH PRE-TAX MONEY
Whether your company benefits include medical aid or not, if your employer is willing to structure your package so that your medical aid contribution comes off before you pay tax, it can save you money.
7. BE PHARMACY SAVVY
“You can save up to 30 percent on your prescription costs by going generic,” says Dr Steve Miller, who works with a pharmacy benefit-management company. Ask your doctor if there’s a proven generic version of the medication he’s prescribing. “They have the same quality and safety records as brand-name medicines,” he says. If there’s not one on the market yet, ask your doctor if there’s a less expensive but equally effective alternative to the drug she’s prescribing.
8. BE A PILL SPLITTER
“Some drugs cost the same in high and low dosages,” says pharmacist Hae Mi Choe. If you’re on medication, such as one for high cholesterol, ask your doctor if she can write you a prescription for a high-dose pill. You can cut it in half at home, says Choe. She recently conducted a study that found patients could save up to 50 percent on their drug costs by simply dividing their pills. But this does not apply to all drugs. “Some, such as capsules, coated pills, and time-release formulas, shouldn’t be cut,” says Choe. “So consult your doctor or pharmacist first.” To ensure you always take an accurate dose, use a proper pill-splitting tool, available at pharmacies.
9. FIND A DISCOUNT CHEMIST
There are countrywide chains of great discount pharmacies which take advantage of the lower prices associated with large volumes of products, and then pass some of the savings on to us. Locate your nearest one, and get a loyalty card which offers cash back for further savings.
10. TAKE ADVANTAGE OF FREEBIES ON YOUR PLAN
“Your medical aid plan may cover all sorts of non-traditional services for free or at a discount,” says Lankford. Many companies in SA are investing in encouraging their members to be healthy. Check to see if yours offers discounts on — or pays for — essential health checks, smoking-cessation programmes, weight-loss or nutrition counselling, gym memberships, magazine subscriptions, travel, and even healthy grocery purchases.
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