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Medical scheme blues

When it comes to medical schemes, I wear three different hats.

Firstly, I belong to our Media24 inhouse scheme, which is administered by Discovery, secondly, I am a trustee and board member of said Nasmed scheme, and thirdly I work as a medical journalist.

This puts me in a unique position, in that I get to see medical scheme issues from all three viewpoints. When I am thinking as a medical scheme member, my thinking is as follows:

I pay lots of money every month for this cover, and when I need medical attention, I want the scheme to cough up. I have been paying for 12 years now, I have never been hospitalised in my life, so if something horrible were to happen to me tomorrow, I want to know that I am covered. Up until now I have always found the scheme efficient and helpful and prompt to pay, but I have belonged to other schemes before, which were a nightmare. Every excuse was found not to settle medical bills, claims were "lost" (oddly enough only the big ones, but the little ones sent in the same envelope were paid swiftly) and getting through to them was more difficult than moving the Union Buildings a metre to the left. I feel for scheme members who are still experiencing this sort of service.

As a trustee I represent other members on the Board of Trustees, and my role is to speak up and raise issues which affect fellow members on the scheme. As a board member I also have some insight into the finances of the scheme. The only income of the scheme is membership fees and the expenditure is administration and medical costs. Medical schemes as such are non-profit organisations. The only money to be made is on the administration. As a board member, high-cost claims make my throat constrict, because I know a few of those could cripple many schemes.

As a journalist, I am frequently writing about medical schemes – from the perspective of the members (mostly the disgruntled ones – the happy ones don't contact us) and the medical schemes themselves.

So, in short, I want my medical scheme to pay for everything I claim, yet I want it to remain solvent, and if it doesn't, I will write an article about it. Whoever said life was simple?

Tell us about your experiences with your medical scheme. 

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