Medical aids and pains in the neck

With the continual hike of the petrol price and the rising tide of everything else it affects, our pockets are growing holes at a rapid rate. So naturally when it comes to our Medical aid, all of us would like to think that our monthly premium is all that’s required from us and going forward we’ll be covered for any hospitalization that might come our way. However, like with all insurance companies, there are clauses that go unchecked and important information between the lines that go unmissed.

 “Many people get confused and have common misconceptions towards what their plan type and Medical Aid will cover” states Rochez O’ Grady, a Pre-Authorization consultant working at a large Medical Aid company in Cape Town. “It’s not that people are unprepared, there is just so much information and red tape for some procedures that it’s impossible to know it all”.

After speaking to numerous people in the industry to help clear the muddy water, I put together some useful guidelines, essential to not being caught in the headlights of a humongous Medical Aid freighter and hopefully save you some grey hairs.

1)     You know what they say about assumptions…

Medical Aids have a lot of red tape, especially when it comes to uncommon treatment. It’s imperative to phone their call center or email them your query as to how your specific plan would cover your procedure. This phone call or email may cost 5 minutes of your time but it could save you thousands of rands. As in the case of Luke Viviers who found out only after he paid his specialist, GP and MRi bills, that his medical aid plan would not cover his treatment. “If I had known my plan didn’t cover joint procedures as common as mine, I would never have chosen it” states an angry  Viviers. “If I had phoned in before I went to the GP, I could have saved a lot of money and hassle. Now I not only have an aching shoulder but also a sore back pocket”.

 

2)     Get those digits

A reference number seems pointless on most occasions, much like the 5cents change they give you at the supermarket. However, it is extremely important to remember who gave you the information and details about your treatment. If you start to hear new information that’s not similar to what you’ve heard previously, you can use the reference number to go back on what the previous agent said. “It’s a good idea to keep a note pad with all the information regarding your treatment, especially the names of the consultants you spoke to and the reference numbers they gave you.” states O’ Grady.

 

3)     You can’t run away from rates and taxes

Most Doctors and anesthetists charge above the “medical aid rates”. Meaning you will be liable for anything above what the medical aid pays out. For example, if your plan type pays out at 200 percent of medical aid rates and the doctor is charging 230 percent, you will be liable for the amount above 200 percent. Now this might not seem like much but remember there might be an anesthetist involved and these amounts can be as much as 400 percent in some instances. The medical aid should know if the doctor and the anesthetist are contracted in with your medical aid rates. If not, there is a 99 percent chance you will need to fork out some money to pay the doctors bills. Speak to your doctor about the rates, it’s a service they are offering and they are not unwilling to reduce their rates.

 

4)     Being early is not always a bad thing

Medical aids require you to call in for an authorization number at least 48hours before your in-hospital procedure. Phone in as soon as you find out you’ve been booked for the procedure. The earlier you are, the less stress you need to deal with before your procedure. If the procedure you’re undergoing is one of the unlucky ones to be bound by red tape, it could take up to 10 business days to gain approval. They might even need a letter of motivation from the doctor involved and additional tests to be done to assess whether they will fund the procedure.

 

5)     A little love goes a long way

“A friendly caller goes a long way and it will be rewarded” says O’Grady. A sure way to make the process more frustrating is to be aggressive or rude with the consultant. “Most of the agents you speak to are really kind and helpful people. However the high demand of call volumes everyday – sometimes as many as 100 calls a day – can get taxing” advises O’ Grady. Be straightforward, clear and assertive. Try and make the agent who’s dealing with your query fully responsible with the outcome of your case, this is a lot easier than dealing with 4 or 5 different agents across the country and explaining you’re story countless times.

 

6)     Don’t trust anyone, especially not the hospital

I know this seems contrary to belief but it’s meant on the administration side. Some hospitals will do all the leg work for you (gaining an authorization number, calling the call center, etc.) but on most occasions they won’t inform you if the doctors are fully covered by your insurance provider. There have been cases when the hospital has made critical errors, leaving the patient to pick up the slack or even fit the bill. Matthew Riley received a text message from his medical aid wishing him good luck with his delivery date and motherhood. “I started to think I was going crazy but when I phoned my medical aid they advised me that the hospital called for the patient concerned and the cellphone numbers were incorrect on their system. So I received her message.”  If the hospital has phoned the medical aid for you, make sure to double check and make sure everything is covered from the nature of the procedure down to the maternity benefits, if that’s the case.

 

There are many processes happening behind the scenes at your medical aid branch but if you go into the process prepared, early and with an inquisitive mindset, you won’t be disappointed and possibly prevent you from explaining to your wife or husband why you received a maternity package from your medical aid. Good luck

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‘The Human, Earth Project’

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Ben Randall, a tall, unimposing man of 31 years, is still searching for his friend who vanished from her village and family in Vietnam three years ago.

Randall is spearheading a movement he calls ‘The Human, Earth Project’, an audacious endeavor to create awareness on the seedy underworld of human trafficking in Asia and around the world.

“In a country the size of China, there are tens of millions more males than females due to the one child policy adopted by China,” states Randall.

“What ends up happening is you have tens of millions of males who can’t find wives, making China a major industry for importing woman to be sold as prostitutes or wives from neighbouring countries.”

Where it all began

In September 2008, Randall set off on a trip to Asia with his brother. The landscapes inspired him and even more so, the humble and kind people he met.

During his three year stay in Asia, Randall took portraits of locals and villagers on his travels but felt that the barrier of a camera lens was preventing a deeper connection with the people. In his third year, he sent his camera home, but not before 100 portraits were captured of young and old all across Asia.

One specific black and white portrait is of a young Hmong girl named “M”. The Hmong are an Asian ethnic minority group from mountainous regions across South East Asia.

Randall befriended M, who at the time was fifteen years old, while teaching English in Vietnam. The friendship continued throughout his stay in the Vietnamese village where he worked.

A year after meeting M, while Randall was travelling through Nepal, he was informed that M had gone missing. Details were scarce and rumors spread of an alleged kidnapping and trafficking across the border into China.

Randall found that this was not an uncommon incident in Vietnam. It forced his eyes to peer into a darker side of Asia he hadn’t seen before.

Hagar International, a global research company assisting women and children who have been affected by human rights abuse, report that since 1990, four-hundred thousand people have been exploited due to human trafficking in Vietnam alone.

The mission

On the tenth of September 2013, five years to the day when Ben first arrived in Asia, he will return to the continent that has played such a colossal role in his life, accompanied by Italian photographer and film maker, Moreno Paulon, to try and rescue M.

“If we can’t find M, hopefully we can let people see what’s happening and stop the same thing from happening to girls in a similar situation,” states Randall.

Randall and Paulon will follow the same route as Randall took five years before; they will also be searching for the one hundred people he took portraits of on his previous journey.

“When you take a photograph of somebody, you’re only taking something superficial; a photograph only really shows the differences between people,” states Randall.

“So the idea is to go back and meet these people and find out who they are with more of an emphasis on what we have in common than on our differences and  to see them as people, not just subjects in a photograph.”

Through this process, Randall hopes to create awareness on the trafficking world, which to date is estimated to affect 20.9 million persons worldwide.

A feature length documentary is being made of the journey to rescue M and uncover the trafficking situation in Asia.

“We’ll be travelling around and as we go we will be putting up videos, stories and photographs on our website online, so people can share in our adventure and follow us along our path.

“Human Trafficking is a huge issue in Asia and even after living in these places for years, I didn’t realize the seriousness of it,” states Randall.

The future

Searching for M will be a massive challenge and when questioned concerning the task, Randall says in a worried but assertive tone, “You might say it’s not the smartest thing going into a foreign country, asking questions and messing about with organized crime, but we’ll do what we can.”

To find out what you can do to help or if you would like more information on the project, go to:

‘The Human, Earth Project’