Medical scheme members face an increasing risk of a large out-of-pocket payment if they don't abide by the rules of their schemes. As demand for healthcare services rises along with costs, schemes are devising rules about which hospitals, doctors and other healthcare providers you can use, and are imposing limits on expensive procedures such as diagnostic scans and on treatment for cancer. Insurers have stepped into the breach to offer protection against these shortfalls, but these policies are also complex to navigate, a survey released this week by GTC's head of healthcare consulting, Jill Larkan, shows. The gaps you may face in your medical cover arise in four major areas: • Doctors who charge higher tariffs than the scheme is prepared to pay - especially in the case of specialists whose services are in short supply; • Co-payments charged by schemes as a way of getting you (or your doctor) to consider carefully if you really need certain high-cost services, or if you really want ...
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