Updated 02 July 2015

Why choosing cheaper medical cover can cost you in the long run

Medical cover is expensive, and getting more so every year. Unfortunately this could mean we opt for lower monthly premiums that could mean you aren't covered in the event of an expensive procedure.


The South African Society of Anaesthesiologists (SASA) is advising South Africans to consider the multiple factors affecting cover when choosing access to medical care.

The SASA understands that healthcare is often hard to comprehend and expensive to access. As a result, the Society believes, many consumers choose their medical plans – including how much cover it offers and whether care is provided at public or private institutions – based on the principle of “what can I afford monthly”.  

“The truth is, most people look at cutting their medical costs in an effort to reduce their household spend when they feel an economic pinch. This is a difficult decision, since we’d all like to have access to the best facilities and treatment with the least out of pocket costs,” says Natalie Zimmelman, CEO of the SASA.

“There’s a myriad of medical care options; most making choosing the best plan for you and your family challenging.”

Zimmelman says options are often difficult to compare and, while it can be hard for consumers to understand what they are covered for and what not, automatically choosing the low-cost approach could be very expensive in the long run. 

The potential limitations on treatment and high co-payment responsibilities can result when the actual costs of the treatment required is not covered by the plan limits. 

Consumers often have no real idea of the actual cost of treatment when looking at the Rand value offered for that treatment within the plan, or even if that treatment is sufficient for their individual diagnosis, underlying conditions and health.

SASA believes that consumers are often not alerted to the fact that some services, such as anaesthesia, cannot be differentiated according to levels. An anaesthesiologist, or any other specialist with a rare skill, will need to provide treatment of the highest standard of skill and care, regardless of the patient’s healthcare plan and the same treatment cannot be charged at different prices.

The gap created between benefits to patients and specialists’ charges often results in the service provider ending up carrying the shortfall of the costs.

“Doctors are often compromised and get embroiled in administrative battles to recoup uncovered costs from patients, putting them in bad financial positions, and spending scarce time on administration instead of treating patients,” says Zimmelman.

In light of the above, the SASA urges consumers to review their plans and speak to their medical care providers to understand their cover in real detail and prevent costly surprises.

It also encourages people to make use of the Council for Medical Schemes, which regulates medical aid schemes in South Africa and to remember that the Competition Commission has called for individuals to make public submissions about the state of private healthcare directly at

Read more:

What to look out for when choosing a medical scheme

20 claims medical schemes don’t have to pay for


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