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.