A guide to help understand medical bills and medical insurance

Explaining medical bills and medical aid/insurance at the stressful time of a breast cancer diagnosis is, unfortunately, a necessary evil. It is best to be well-informed of liabilities around any medical costs up front. This should alleviate stress in and around treatment going forward.

It seems most of us assume that our medical aid/insurance will cover all of our costs and pay over monies directly to the medical service provider but this isn’t always necessarily so. Many years ago there was a contract between the medical aid and provider of medical services; bills were often not even seen by the patient. Currently, however, the contract is between the patient, the medical service provider and their chosen medical insurance.

Why does this happen?

When a patient joins a medical aid/insurance, many ‘plan types’ are on offer, from full cover to lower cost-effective cover and hospital plans. This means the patient is choosing the cover they can afford at that time, but not many of us read the fine print.

What does this mean to you as a patient?

Patients are often under the impression that their medical aid covers every cent of their medical bills. However, generally, there will always be a portion that patients are liable for; sometimes a third or even up to two thirds of an account (hospital bill included). Many medical insurances now pop the monies into the patient’s account and do not pay doctors directly.

What can the patient do?

Gap cover – it protects you, by covering your medical aid/insurance plan’s payment shortfall during hospitalisation. There are a few different types, some will pay out a daily payment after a 24-hour stay in hospital while others will pay the difference not covered by the medical aid/insurance. Most insurance companies offer gap cover policies. Worth a look into I think!

A little peak into Insurance form claims

Read insurance forms carefully when claiming for a breast cancer. Often, but not always, the insurance pays out a percentage of the funds based on the ‘staging’ of the cancer. Final staging can only be known once definitive surgery has been performed. In-situ (sleeping cancers) may be excluded from the claim.

Remember always check with your medical service provider and medical aid/insurance what costs you will be liable for and most of all don’t stress! There are options available to all patients irrelevant of financial status.

Written by Julie Belloni.

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