Don't run out of medical aid funds

With many healthcare service providers charging exorbitant fees (a five-minute visit to the GP today can set us back many hundreds of rands) and other healthcare costs rising, the Sunday Times recently reported that more than half of South Africa's eight million medical aid members were either broke halfway through the year, or quickly running out of funds to cover their day-to-day medical expenses.

Getting value for money

When money is scarce, people want to pay as little as possible while deriving the maximum benefits from their purchases. Here are some tips from Pro Sano's clinical operations executive, Dr James Arens on hidden medical costs to beware of, and clever ways to stretch out your benefits so that they last you the whole year through.

1. Find your fit

Medical cover can be a significant monthly expense, so it's important to compare plans to find the best option for your family's needs. When planning your healthcare cover, write down a basic medical history for each member of the family, including treatment they are likely to require in the year ahead. Options range from hospital benefits only to fully comprehensive cover. Choose an option that suits both your needs and your budget.

2. Go for generics

Many medical aids encourage people to use more cost-effective equivalent medicines and this can provide a huge saving. Always ask the pharmacist if there is a generic equivalent of the drug your doctor has prescribed and what the cost difference would be. Remember, at the end of the day you are spending your own money, so be prudent wherever you can.

3. Get what you pay for, pay for what you get

When consulting a doctor or any other service provider, always make a habit of understanding what you have been charged for. Review and monitor your claims statements closely and query any irregularities with the service provider. It is also advisable to report any irregularities directly to the scheme. Members need to play an active role in protecting their benefits from potential abuse.

4. Talk about costs and don't be afraid to get a second opinion

Most of us take the word of our medical service provider at face value and rarely dare to question his or her costs and charges. However, who would buy a house or a holiday without getting a quote upfront or at least having a very good idea of the costs involved? It is not unreasonable to discuss the cost of your treatment with your doctor - especially where additional co-payments are required from the member. The same goes with getting a second opinion. If you feel it is justified, your scheme may facilitate and even grant additional funding for a reasonable request for a second opinion.

5. Don't be shy to negotiate discounts

You wouldn't dream of buying a car without negotiating a good deal, so why are most of us so shy or downright embarrassed to ask for a fair price when it comes to healthcare? Members need to get into the habit of negotiating discounts with their service providers in order to get more out of their benefits.

6. Use designated service providers

Designated service providers (DSPs) are preferred service providers with whom your medical scheme has pre-negotiated discounts on behalf of its members. Utilising these DSPs is a sure way of preserving your benefits and paying reduced rates. Find out more by speaking to your medical aid.

7. Don't rush off to the doctor with every sniffle

Keep unexpired medicines in a safe cupboard. In cases where you have a minor health concern, call your GP regarding the symptoms and mention what you have in your cupboard. In most cases doctors are happy to discuss such matters with their patients.

8. Beware of doubling up on tests and lab work

X-rays and laboratory results are the property of the patient. Before embarking on a new battery of medical tests, always inform your doctor where and when you had your recent tests. You are also entitled to all your clinical records from previous doctors.

9. Be prudent with your medical savings

The message here is don't abuse your benefits. Once your savings are depleted, that's it until the next year. Members should always be aware that the benefits allocated to them are indeed their own money and need to be managed as such.

10. Always get authorisation

For hospitalisation or expensive procedures it is safer and mandatory by most schemes that you call in to get formal authorisation for the admission or procedure. The authorisation department validates the procedure codes against the diagnostic codes to ensure that member only pays for what is absolutely required for the procedure by national and international standards and guidelines. Members are encouraged to call in personally to get first-hand information on any exclusions that may result in the member having to pay additional expenses that are not covered by medical aid.

11. Find out if you qualify for special benefits

Several schemes offer special benefits at no extra charge. For example, Pro Sano Medical Scheme offers free Pro Baby Maternity, HIV and Aids, Oncology and Chronic illness programmes to members on certain options, which provides a range of additional benefits and cost savings. However, beware of added clutter offered by some medical schemes that you invariably end up paying for. Read the fine print and know what you are getting - and paying for.

12. Stay on top of things

The last word from Dr Arens: Take responsibility for your own healthcare. Don't trust someone else to manage your medical expenses, he says. The best person to look after your money is you. In the case of medical schemes, as with anything else, this requires vigilance and a great deal of involvement from the member.