Picture: 123RF/nito500
Picture: 123RF/nito500

There have been numerous complaints regarding medical aid rule changes and practices that have hurt many.

I was told by my medical aid about a year ago that medical inflation is so high — about double the official inflation rate — because many practitioners and hospitals charge excessively and there is a lot of fraud in the industry.

Based on personal experience, that seems to be true.

However, here are a few other facts:

• Premiums have risen by about 10% annually for some years;

• Rules are complicated in an obvious effort to confuse members — as are unnecessary limits placed on dentistry, medication, various forms of therapy and the like;

• Reimbursements are terrible, with a regular consultation for GPs and specialists reimbursed at about R365. Most GPs charge significantly more than this, and you would be hard-pressed to find a specialist whose consultation fees are within 300% of this; and

• There is the self-payment gap — an amount that a member has to pay personally once his or her medical savings account is depleted and before the above-threshold benefits kick in. It clearly states in the policy document that the self-payment gap is a predetermined amount. However, in practice, this amount keeps increasing for a range of reasons, which one can find in the fine print.

As a pensioner, I need to maintain medical aid membership in case of serious illness or injury. In the meanwhile, I remain a mugging victim.

I do not believe in price controls, but I believe we should all be protected from unscrupulous get-rich-quick practitioners, along with most medical schemes.

D Wolpert