My husband and I were having our nightly bath chat last evening. We got onto the topic of medical aids and elective caesarians (not such a difficult topic to steer to in our home) and it got me thinking that as medical aid members, we are subsidizing other members’ medical procedures. Surely then, I should have a say where my money is going? Or surely I should be able to sign up to understand how they (the MAs) with a clear conscious are spending my money?
Take this into consideration, a homebirth – with all paraphernalia and including all prenatal visits with a midwife could cost about R8 000 + a doula at a stretch. An elective caesarian (just for the operation!) costs R30 000 + hospital cover + 12 gynae visits + scans. Conclusively an elective caesarian costs 5 times what a homebirth costs – and MY money is going towards that! I am all for pro-choice but this is not the mothers choice, this is the gynaecologist getting rebates from the medical aid for choosing an unnecessary medical procedure for the mother and baby. Yet, my monthly medical aid costs are now in excess of R3000 for myself and my husband. My R3000 is subsidizing a procedure which in 70% of cases in the private sector in
Discovery (
Medical aids like to call their products “consumer-driven plans”, this is a bit of an redundant comment.
“Consumers have an unlimited demand for healthcare, but the resources available to medical schemes to pay for healthcare services are limited to members' contributions. Someone has to ration healthcare, and it is best if consumers do so themselves, says Adrian Gore, the chief executive of Discovery Health.
If schemes do not give consumers the power to decide how to ration their own healthcare, schemes are likely to fail, he adds.”
I would love to see this happen, pipe dreams Mr Gore, pipe dreams.
* source: www.persfin.co.za
2 comments:
Well, medical aids *claim* that they pay for home births. Some measly little amount like R1600 was promised for my first birth (midwife charged R3000 at the time for the birth). Sasolmed got confused and paid out a midwife appointment, so I got R50 for that birth. For the next I was super-prepared, made sure I had the right codes on the page etc etc. And they just kept losing the submission with the birth on, until the baby was over 4 months old and the claim was "stale". Convenient, hey? I'm now on Profmed, will see how they are, but my plan, although it pays 300% of many medical aid rates just pays out medical aid rate for home birth. So R1800 of R6000 midwife's fee, and that's assuming they aren't into the fun and games with a tired new mommy that Sasolmed were. My midwife suggested writing a letter to explain I was saving them money by having a homebirth, but I'm not naive enough to think that they want to pay out a cent more than they've written in their benefits code, even though they have a mystery R14000 "home nursing fee" for someone who has a home birth or goes home within 24 hours of the birth. I doubt they'd let me use it to top up the actual amounts paid to the midwife for the birth and post-natal appointments.
Your post is definitely food for thought Milly. I don't understand why most medical aids refuse to pay for home births, it makes no sense whatsoever. I think you should copy and paste this a letter and send it off to Discovery....you never know, you might make someone in Management rethink things :)
Post a Comment