Claims

 

Hospital cash-back plans crimped by new law

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The demarcation regulations clearly distinguish between medical insurance products and medical aid schemes. For the consumer, this means that while limited gap cover and hospital cash-back plans will still be allowed, primary healthcare insurance policies will no longer be available. All existing policies will need to align with the regulations from 1 January 2018.

Affected markets

These regulations will primarily affect those between 20 and 35 years of age. The annual Council for Medical Schemes (CMS) report shows that children up to the age of 20 usually stay on their parents’ medical aid. Then you see a significant drop in the number of dependents between the ages of 20 to 35, and then the line goes up again. This is a clear indication that the young and healthy are exercising their freedom of choice to not have medical aid cover. This is the group that, until now, has often relied on hospital cash-back plans for catastrophe cover.
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Meet The Robin Hood Of Medical Scheme Rip-Offs: Clawing Back Big Sums – For A Modest Fee

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An entrepreneur has come up with a clever way to tackle the beast of medical scheme rip-offs. Instead of joining the throng of service providers who are squeezing private scheme members for ever greater sums, this Robin Hood of the healthcare sector has identified a way to claw back thousands of rands – for a modest fee.

Independent journalist Ed Herbst, who has an unwavering instinct to uncover news at every opportunity, discovered this enterprise while chatting to a neighbour. The details of this service are too important not to share, he reckons, highlighting how tens of thousands of rands are being directed back to their rightful owners. In a nutshell, the doctor who has started this service has made it his business to cut through complexities and legal nuances and has exposed questionable practices in the process. He can do it for less than R400, all in, and has saved people from bad credit records and cut the additional stress that comes with trying to find
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How to choose a medical aid

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Most medical schemes have launched their benefits and contributions for 2017 and it is the time when you should be re-looking at your existing medical aid cover or, if you are wanting to join a scheme, investigating which one suits you best.

The medical aid landscape can be tricky to navigate so it is important to compare options and schemes to ensure you find a medical aid that works for you and your family’s health and is within your budget.

Dr Bobby Ramasia, Principal Executive Officer of Bonitas Medical Fund, helps guide you through choosing the best plan, whether it’s through the open market or through an employer.

If you are already on a medical aid scheme

Before you choose the best medical aid option, you need an idea of what your typical health care costs are.

You should also consider the following for you and your dependants over the past twelve months:

How much you spent on day-to-day healthcare expenses
Where you or an
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Genesis wins case on accounting for use of medical savings funds

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On Tuesday, the Constitutional Court ruled that all funds paid by members to their schemes should be considered as assets, regardless of their intended use.

Genesis medical scheme has won its legal battle with the Council of Medical Schemes over how to account for the funds in members’ medical savings accounts (MSAs), a development that has potentially far-reaching implications for both the industry and consumers.

This technical accounting point will make a material difference in the way schemes calculate their solvency ratios that measure gross income against reserves.

Treating MSA balances as assets means schemes’ reported solvency ratios will improve, because funds accumulated in MSAs will now be considered as part of a schemes’ reserves, said Insight Actuaries joint CEO Barry Childs.

This is important because better solvency ratios mean less pressure on schemes to increase premiums.

The judgment overturned a high court ruling that the council has us
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Natural Cold and Flu Remedies

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Natural Cold and Flu Remedies

It’s no wonder these kinds of treatments are popular — we still have no cure for colds or the flu. While the flu vaccine may prevent the flu, and some prescription medications may shorten its symptoms, most conventional medications just ease symptoms. Many natural remedies can give you short-term relief as well, and a few may help you get better. See which ones show the most promise.

Echinacea
This herbal supplement may boost your immune system and help fight infections. But it’s unclear whether that helps you fight off colds. Most evidence shows echinacea doesn’t help prevent a cold, but some research found it shortens symptoms by a day or two. Other studies say it has no effect. To try it, take it when you start to feel bad and continue for 7 to 10 days.

Zinc
Some studies show it helps fight viruses, like the cold. They say the mineral stops certain proteins from forming before cold virus
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The real reason SA’s doctors won’t deliver your baby

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Medico-legal litigation has exploded. As of March 2016, claims against the health department from the previous five years stood at more than R37‑billion. By October that year, the figure had jumped to R51‑billion — or a third of the whole public healthcare budget if we had to pay every cent.

The medico-legal litigation pandemic threatens not only our health system but also the very existence of our mothers and children.

When some see these figures, their first reaction is to condemn the health department and accuse it of absolute carelessness. Please be careful before drawing such conclusions. Ask yourself first: But what has changed?

It is common knowledge that, over the decades, an overwhelming number of medico-legal litigation cases were lodged against the Road Accident Fund (RAF).

The RAF has since been litigated into a state of near-bankruptcy and is finding it difficult to even pay legitimate claims. The minister of finance has tried to raise th
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Medical aid board says SA has no choice but to back NHI

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South Africa’s healthcare system is not merely unviable or unsustainable, “it is at the brink of collapse” if the government does not intervene, says the Board of Healthcare Funders, which represents most medical aid schemes in the country.

“People are paying contributions to their medical schemes that are higher than inflation,” Humphrey Zokufa, who heads the board, said on Tuesday at a media briefing in Johannesburg.

He said that people have to pay copayments and their benefits run out. In addition, the pool of insured people is not increasing and those who are insured are ageing.

“In a situation like this, government has no option but to intervene, and that intervention is taking the form of the National Health Insurance [NHI].”

The NHI is a plan for significant reforms to the public and private health sectors and aims to make affordable healthcare available to all South Africans by pooling money from various sources, such as the Road Accident Fund
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Medical fraud costs the country’s economy

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The phenomenon of suspiciously qualified or unqualified doctors opening shop in some township and attracting unsuspecting patients has become a concerning norm.

Discussions and debate are focused on state capture and its effect on the economy, but there’s another beast eating away at productivity, hurting the economy and undermining our health system. South Africa is open for medical fraud business.

Medical fraud manifests in two ways: bogus doctors in practice and bogus medical certificates issued to rob employers by keeping an employee away from work while earning a salary.

The phenomenon of suspiciously qualified or unqualified doctors opening practices in some townships and attracting unsuspecting patients has become a concerning norm. Just recently a bogus doctor was caught and arrested at his Mpumalanga surgery in front of patients, some of whom he had prescribed highly regulated schedule 4+ drugs.

These bogus doctors – and even dentists and special
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Medical Schemes Act & NHI:- Motsoaledi outlines changes

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Two of the proposed amendments to the Medical Schemes Act will do away with co-payments, and abolish the practice of using brokers within the medical schemes environment.

Health Minister, Dr Aaron Motsoaledi, said co-payments mean that the scheme pays a portion of the bill that a provider – be it hospital or private doctor – charges to a patient. The rest of the funds are supposed to be paid by the patient from their own pocket.

“The amendment means that every cent charged to the patient must be settled fully by the scheme and the patient should not be burdened with having to pay. There are people who will scream that this amendment is outrageous and calculated to destroy medical schemes and leave beneficiaries with nothing. I want to assure you that this was well thought out,” he said.

According to data at the department’s disposal, medical schemes are holding close to R60bn in unused reserves. While there is a statutory requirement that me
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Medici medical app launches in South Africa

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A medical app, Medici, that is said to be revolutionising the doctor-patient relationship, is now available in South Africa. The next-generation secure messaging app enables users to communicate virtually with medical providers via text, call, or video.

Originally launched in the U.S., the app hosts an array of practitioners including family physicians, paediatricians, dermatologists, dentists, mental health providers, nutritionists, dieticians and even veterinarians, providing a more convenient and modernised method of consultation to suit all healthcare needs.

App users will receive a consultation receipt so that patients are able to claim back from their medical aid provider. Patients who aren’t covered by a medical aid will also benefit from the app as a result of the consultation fee being significantly lower than traditional examinations.

Partnerships

Medici Africa has partnered with Dr Michael Mol and Hello Doctor, already servicing
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Former execs slapped the firm KPMG for R30m

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Two former KPMG directors who left because of the scandal involving the audit firm and VBS Mutual Bank have slapped the firm with multimillion-rand law suits for defamation and discrimination. But by doing so it has emerged that they were indebted to the embattled VBS — including for an almost R8‑million home loan.
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Best and worst medical aids in South Africa.

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The latest GTC Medical Aid Survey for 2016 has been released, which compares local medical aid schemes on price across various levels of cover.

According to the latest General Household Survey from Stats SA, only 17.5% of South Africans are covered by medical aid.

Between 2002 and 2015, individuals who were covered by a medical aid scheme increased from 7.3 million to 9.5 million persons.

According to the Council for Medical Schemes’ Annual Report, released in July 2015, 37.55% of all medical aid costs were in-hospital, followed by 23.51% from specialists of which less than 10% was attributable to out-of-hospital services.

This reflects a total of almost 61% of healthcare costs paid for by medical aids were for in-hospital procedures. Expenditure on all health benefits by medical schemes rose by 11.1% in 2014 to reach R124.1 billion.

The GTC makes an admission that trying to compare medical aid schemes in a comprehensive way is virtually impossible due
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‘No money for medicines’ shock – What is going to happen to the patients ???

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Patients’ anti-depressant, anti-anxiety drugs cut – but department denies shortage

State patients needing anti-anxiety drugs or anti-depressants are being turned away from Provincial Hospital’s outpatient clinic and told by the nurses to buy their own drugs or that they do not need pills to stop an anxiety attack.

“I have lost so much weight that I now fit in a size 30 dress,” Cilla Uys, 67, said.

She developed an anxiety disorder after her husband was murdered. “I need my pills.”

Petro Wessels said: “They told me to drink less coffee and exercise more.”

Shelly Strimling, 50, was given a prescription for her anti-depressants on Thursday and told to go and buy the pills herself at the pharmacy. They cost R485.

“There are many others like me,” she said. “I am collecting letters of complaint to take to the Department of Health.”

Strimling has been a state patient for eight months.

When she went to collect her pills at the
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Is your GP contracted in to a medical scheme network?

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If GPs are contracted in to a medical scheme network, they might be pressurised to recommend cheaper treatment options and medications, say SA health bodies.

The Board of Healthcare Funders (BHF) and the IPA Foundation (IPAF) is extremely concerned at the comments made recently by the Health Professions Council of South Africa concerning Designated Service Providers (DSPs).

The HPCSA recently released a statement to the effect that healthcare practitioners should be cautious when concluding designated service provider (DSP) agreements with medical schemes as the medical schemes attempted to reduce costs by applying pressure on practitioners within a DSP network to prescribe medication or recommend treatment options, when other more appropriate, albeit more expensive, options were medically indicated and readily available.

Pushing healthcare costs down

In the current environment where there are no regulated tariffs for healthcare procedures,
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Why opting out for a cheaper medical cover can cost you in the long run

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Medical cover is expensive, and getting more so every year. Unfortunately this could mean we opt for lower monthly premiums that could mean you aren’t covered in the event of an expensive procedure.

The South African Society of Anaesthesiologists (SASA) is advising South Africans to consider the multiple factors affecting cover when choosing access to medical care.

The SASA understands that healthcare is often hard to comprehend and expensive to access. As a result, the Society believes, many consumers choose their medical plans – including how much cover it offers and whether care is provided at public or private institutions – based on the principle of “what can I afford monthly”.

“The truth is, most people look at cutting their medical costs in an effort to reduce their household spend when they feel an economic pinch. This is a difficult decision, since we’d all like to have access to the best facilities and treatment with the least out of pock
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