|
Category:
Insurance
News /
Medical Schemes /
Telemed
/ May 2007
SA medical schemes conned by `healthy
patients'
Local medical schemes are falling
victim to an increasing trend of members abusing benefits provided,
by making unnecessary claims, for a variety of reasons. Many are
`professional patients', a term used to describe otherwise healthy
medical aid members who pretend that they are or in some cases
believe that they are genuinely sick. This has a knock-on effect by
absorbing resources and funds that could have been better used by
those that most need it.
 Whilst `professional patients' are
often recognized as having a genuine psychiatric condition, it is
often left undiagnosed or even ignored by service providers. A
member with this psychiatric condition can very quickly drain
resources and some unscrupulous service providers may even exploit
this condition for their own financial gain. It is for this reason
that more attention must be paid to the claims history of members in
order to spot those who might more appropriately avail themselves of
psychiatric assessment. Whilst often an expensive route to take in
the short term, it could potentially be a money saver for the
medical scheme and therefore benefit the majority of its members.
It is the members of medical aid
schemes that end up compensating these questionably unstable
malingerers by paying ever increasing premiums. Though by no means
the sole reason for premium increases, it would appear to be an
ever-more evident factor.
For far too long, medical schemes have
been forced to swallow this bitter pill and have had very little
opportunity to deal with or redress this concern. That is until now.
Local medical aid scheme, Telemed have
put in place an action plan to deal with this phenomenon. This
includes closer monitoring of members' GP visits, monitoring of
tests and procedures, and monitoring of prescription medication, all
notified as key areas in which `professional patients' make false
claims.
Carel
Stadler, CEO of Telemed, explains, "At Telemed we are not prepared
to compromise our service, by pandering to the whims and fantasies
of the minority who use doctors, hospitals and medication as a form
of escapism. By putting in this methodology, we will be able to
focus more funds on those who really need care in South Africa."
Stadler
continues, "Related to this trend is the ease with which some
service providers put their patients on chronic medication, this is
also an area of major concern. Very often, the patient,
`professional' or otherwise, is left on chronic medication for years
without appropriate monitoring, once again draining valuable
resources."
Stadler
adds "This is far reaching for South Africans and for the industry
as a whole. It's important for all medical aid members to look at
how their scheme monitors how freely they spend their money. It is
as important for local medical aid schemes to stop this shocking
trend by putting in similar measures. It could cost dearly to those
who need the support most."
Telemed is this year celebrating
its 85th birthday, making it one of South Africa's most established
medical aid schemes. Its growth has been built upon a service-driven
mentality and an intensely local focus on its members, evident in
its new campaign to curb and monitor claims behaviour more
thoroughly.
Author:
Eldri Slabbert
(Telemed) -
eldris@telemed.co.za
 |
