IN response to Monday's reports on medical aids, I would like to give my perspective with the hope that administrators of medical schemes can gain some insight into what their members experience.
Over the last two years I have had a family member on an oncology programme. I am grateful that I have a "good" medical aid which could offer such a programme that will ultimately cover all of our oncology-related expenses.
What I am not grateful for, however, is the run around that I am given when trying to sort out a claim. Having had the programme approved, many claims have not been paid as a result of a wrong codes being used or some deviation from the claims procedure on the part of the service provider.
As the member, I only become aware of problems once the claim has been rejected. It is left to me to connect the dots between the medical aid and the service provider, and then I'm met with red tape and resistance.
I have spent days on the telephone, and hours in the accounts offices of service providers as well as the medical aid's offices. Settling claims should be the core business of the medical aid, but I find myself doing all the work until the claim is settled.
I am not trained in settling claims, so it becomes very stressful. In addition to this stress, I have to deal with calls from debt collectors on a frequent basis, all while trying to manage a family devastated by cancer.
It often feels like the medical aid is purposely trying to wear me out, hoping that I will give up and pay the bills myself.
I appeal to the administrators of medical aids to understand what their members may be going through and genuinely assist them in settling claims.
They have the expertise. A little effort spent on their part with the attitude of getting a claim processed rather than having it rejected would be highly appreciated.
Patient (details supplied)