Medical Insurance- the difference between the fortunate and the less fortunate!

What forced me to write this blog was a recent documentary on Satellite TV. To my surprise they broadcasted a very sensitive issue i.e. healthcare. Healthcare is sensitive because this is where you distinguish between the fortunate and the less fortunate or the haves and the haves not. The documentary that I watched was SickO – I sommer roughly translate it in (Afrikaans) as "siek ou" which means sick man, I might be wrong with the way I see it, but I was a victim as well. What pains me was to see that even people from 1^st world countries had to go to other countries to get free healthcare. Our government really wants us to make use of the public health care system which would be a good thing if correctly administered. On advice of the former health minister I decided to make use of public healthcare and try out Chris Hani Baragwanath Hospital what a mess, at first complicated procedures ranging from long queues to staff members who don't care damn, public servants that really give the man on the street an attitude. On presentation of my medical aid insurance card one staffer even asked me why not making use of private facilities. I felt bad and thought about it, but I was under the impression that the service might change. I was so wrong – because at first you waiting in a queue longer that 200meters for a stamp, thereafter another queue for the doctor, then another queue for the pharmacy. If you really want to be helped at any public facility then you must at least woke up at 4am be at the hospital at least by 6am then you will be out of there by 10am, I am convinced and wish to believe that the public facilities are not that bad and the service might even change IF all our public servants are willing to go the extra mile, with a dedicated management and staff supervision. Now to the main point – medical insurance: I was a member with one of the major medical insurance companies in South Africa, they promised during their presentation heaven and earth from 300% cover whilst in hospital to adequate cover either over the counter or private consultations. What forced me to terminate my membership after six loyal years was when one of my dependants needed surgery and the medical aid was not willing to pay for anaesthethics, i.e. the drugs required for sedation before the surgery. The medical insurance refused blatantly, according to them that was excluded on the insurance and I had to foot the bill. These exclusions were never communicated, as we the customers are normally in perfect health when applying for medical insurance. On numerous occasions I had to either settle for generics or pay levies even if the customer still have funds available in their insurance accounts and when no generics were available as a substitute. I am not the kind of person who likes to chop and change products or companies as and when required but I just decided to walk out. Now I'm with another medical insurance company, skeptical but hoping for the best. I was under the impression that these insurance companies were noble. I even remembered that there was a time when I did not make use of medical insurance for a full year, as I call it that it was my lucky year or it was the time that I used over the counter medication at my expense. I even thought at times the reason why medical insurance companies refused to pay for treatment was in order to force their customers not to use the insurance available to the clients. THE MOVIE SICKO then opened my eyes, apparently the board or the management of the particular medical insurance decides what's approve and what not, no wonder the loyal customers suffers when in need of medical assistance or hospitalization. Government is currently preaching NHI – National Health Insurance.

The big question is: WILL THIS NHI WORK – I sincerely hope so….

 

SO many questions… SO little answers…