How to Avoid Medical Aid Shortfalls

10 May 2023

Medical aid shortfalls can be a major financial burden for many medical aid members.

This occurs when your medical aid pays less than what your doctor charges, leaving you with a bill to pay.

These shortfalls can be avoided if you take the right steps.

Here are six tips to help you avoid medical aid shortfalls:

1. Choose the Right Medical Aid Plan

The first step in avoiding medical aid shortfalls is to choose the right medical aid plan. Different medical aid plans offer different levels of cover, so it’s important to choose a plan that meets your needs. Look for a plan that covers the treatments and procedures you’re most likely to need and one that has a reasonable co-payment structure. Make sure you understand the plan’s limits and exclusions.

2. Understand Your Benefits

Once you’ve chosen a medical aid plan, it’s important to understand your benefits. This includes understanding the treatments and procedures that are covered, as well as any limits or exclusions. Make sure you know how much you can claim for each benefit and what co-payments you may need to make.

3. Use Network Providers

Another way to avoid medical aid shortfalls is to use network providers. These are healthcare providers that have agreements with your medical aid to provide services at agreed-upon rates. By using network providers, you can avoid the risk of being charged more than what your medical aid will cover. Check with your medical aid to find out which providers are in their network.

4. Get Pre-Authorisation

Before undergoing any treatments or procedures, it’s important to get pre-authorisation from your medical aid. This involves submitting a request for the treatment or procedure, along with any necessary documentation, to your medical aid for consideration. Pre-authorisation is not a guarantee of payment but allows the member to get a better understanding of what may or may not be covered by their medical aid.

5. Negotiate Fees

If you’re facing a medical aid shortfall, it’s worth trying to negotiate fees with your healthcare provider. Explain your situation and ask if they’re willing to reduce their fees or offer a payment plan. Many healthcare providers are willing to work with patients to find a solution that works for both parties.

6. Invest in Gap Cover

Gap cover, otherwise known as medical shortfall cover, is designed to cover the shortfall between what your medical aid pays and what your healthcare provider charges. It can provide you with much needed additional financial protection and peace of mind.

In conclusion, medical aid shortfalls can be a significant financial burden for medical aid members, but the steps listed above can help in minimising or avoiding medical shortfalls.

If you’re unsure about any aspect of your medical aid coverage, don’t hesitate to contact HealthMax.

Learn more about Zestlife Gap Cover and how it can cover your medical expense shortfalls.

 
The information contained in this communication, including attachments, is not to be construed as advice in terms of the Financial Advisory and Intermediary Services Act of 2002 (“FAIS”) as the writer is neither an appointed representative of Zestlife, nor a licensed financial services provider as contemplated in FAIS. Please consult your Financial Adviser or Zestlife should you require advice of a financial nature and/or intermediary services.