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Category:
Insurance
News /
Medical Schemes /
BESTmed
/ February 2007
Sick patients held to ransom on the operating table
A recent
Consumer Watch article in The Star newspaper, questioning the ethics
of certain healthcare professionals, has left a cloud of uncertainty
for medical aid scheme members.
 Some
anaesthetists are charging rates for their services that are way
above the costs recommended by medical aid schemes. This has led to
a surge in demand for co-payments from unsuspecting medical aid
members, resulting in members and medical aid schemes baulking at
paying what is sometimes 300% above the rate paid by medical
schemes. With the demise of GAP schemes, this critical shortfall is
having to be burdened to the member.
Alarmingly,
emergency cases like road traffic accident victims are not
sufficiently covered by their medical schemes when it comes to the
unforeseen costs charged by anaesthetists and often have to resort
to bargaining with these service providers in order to attempt to
reduce their fees.
"This is a
distasteful and insensitive way to treat patients, especially when
they are at their most vulnerable," Claims Dries le Grange, CEO of
Bestmed Medical Scheme. "Surely a medical scheme member should not
have to concern himself with the cost of his treatment when he
believes that his medical scheme should be covering his expenses.
100% hospital coverage is meaningless if service providers are
charging at rates that would either affect the viability of the
scheme or lead to an increase in premiums to such an extent that
they become unaffordable to the majority of their members," adds Le
Grange.
"We are
literally being held to ransom, we do not want our members paying
co-payments and requesting that they negotiate rates is really the
only viable option" he continues. "Contracting to Bestmed would be a
win-win situation both for the service providers and our members.
The service providers would be assured of members business and our
members would not have to make co-payments. It would take very few
practitioners to make this commitment and for other to follow when
they see the benefits. I find it difficult to comprehend why they
would price themselves out of the market and negatively affect the
very people they have sworn an oath to serve."
Without a new
radical pricing system, the government hospitals will have to take
the strain. This in itself may negate the Government's plans to
enable the less well-off amongst us to join private medical schemes
and alleviate the pressures on the state hospitals.
Critically, the
current situation leaves South Africans unnecessarily vulnerable and
wary on the operating table - an issue which must be addressed
immediately.
Author: Alan
Fritz - General Manager: Corporate Affairs, BESTmed
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