*The content is brought to you in partnership with Discovery Health Medical Scheme
By Deon Kotze*
Know your plan
Understand what you’re covered for, at what rates and with which providers. Does your plan cover you at the medical scheme rate or at a higher rate? Does your plan require you to make use of a hospital or pharmacy network? Refer to the material you receive from your medical scheme, use their website and talk to your financial adviser about what you’re covered for.
Know your doctor’s rates
Patients are often embarrassed to discuss money with their healthcare provider, but when you make the appointment, ask what rates your doctor charges and whether or not you’ll be liable for any co-payments. That way, you can make informed decisions about how you’re spending your healthcare funds. If affordability is your greatest concern, it might be better to shop around for a provider who charges medical scheme rates, but if choice is more important to you than cost and you’re happy to pay more, you’ll know up-front exactly how much.
Tap into any network arrangements your medical scheme may have
Some medical schemes have network arrangements in place with healthcare professionals. By using a healthcare professional on a network, the scheme pays the professional directly, reducing administrative hassle and keeping costs down for you. The Discovery Health Medical Scheme, for example, has an extensive GP network where members are covered in full for GP consultations. We recommend that our members call us or visit our website before they see a healthcare professional, so they know which of these are part of a network.
If your medical scheme offers direct payment arrangements with certain specialists, you can benefit too
For example, Discovery Health Medical Scheme has direct payment arrangements in place with the majority of SA’s specialists on most of its plans. If you see one of these specialists, you won’t be liable for any co-payments. If you choose to see another specialist, you may need to pay up-front or pay a portion of the costs yourself – depending on your plan. Again, visit your medical scheme’s website, consult your policy or call their call centre to find out what your options are. Don’t be afraid to discuss and agree rates with your specialist.
Check for full-cover alternatives
In the case of medicine for a chronic illness, schemes often have formularies, i.e. lists of medicine that are covered in full by the scheme. Check with your doctor or pharmacist if your prescribed medicine is covered in full, and ask about alternatives if not.
Pay in cash for over the counter medicines
If you have a medical savings account, don’t claim for items not normally covered by medical schemes, e.g. over-the-counter headache tablets, cough preparations, etc., from your savings. Paying cash will help the money in your savings account last longer, so you have funds available for more serious, more expensive out-of-hospital treatments.
Stay healthy!
It seems obvious, but people often overlook the fact that by looking after their health, they can reduce their healthcare costs in the long term. Make use of your scheme’s preventative screening benefits for regular health checks, and engage in a healthy lifestyle. In the case of Discovery Health Medical Scheme, members have access to a range of preventative screenings funded by the Scheme. Member can also join Vitality, which rewards them for being healthy!
- Deon Kotze is Head of Technical Marketing at Discovery Health.
