Speak Out About Your Medical Aid Experience

If you’re not aware, there’s been an important public inquiry going on that directly impacts you if you’re a medical scheme member.

It’s the inquiry being conducted by the Competition Commission investigating the way competition plays out in the medical insurance sector. It also seeks to establish how the dream of quality private healthcare that is accessible to all South Africans can become a reality.

It is a timely move that seeks to balance the scales between the private and public healthcare sectors. For a long time scrutiny has been fixed on the state of the public sector but now the weaknesses of the private sector are being brought to light.

In the quest for profits, it appears that the rights of patients, as provided for in the constitution,have been overlooked. Many patients, or medical scheme policyholders have been taken advantage of because of their ignorance.

Competition CommissionThe ignorance is far from willful. Many a time they come to medical service providers when they are in no position to demand that vital information from the medical scheme or healthcare provider. All they want is to cater to have their health catered to. In view of their vulnerable position information is withheld from them that robs them of their power to make decisions beneficial to them. It’s not like when you’re out shopping for clothes where you can go around shopping for the best value.

This explains why the Council for Medical Schemes receives many complaints concerning the Prescribed Minimum Benefits or PMBs. A case in point is where a medical scheme pays for a prosthetic limb, which is listed under PMBs, but declines to pay for the procedure required to insert it. Section 27 of the constitution states that all schemes are required to pay for PMBs in full but such schemes try to find loopholes in the wording so as to minimise claims payouts. No wonder most of the eight million South Africans who rely on the private healthcare sector are dissatisfied.

And this is why an NGO going by the name Section 27 was formed; to hold these providers to account. This organization insists that in choosing to operate in the health sector, the healthcare providers accepted the constitutional obligations to provide access to healthcare.

Up to this point in the inquiry, Section 27 has received a number of submissions, but few of them are from patients. Surprised that the principal party affected is not represented in the inquiry, the lawyers representing Section 27 wondered where the voice of the patient was. For this reason a number of public hearings have been called for, so that members of the private medical schemes can come forward and give their story.

These hearings were to begin mid-2015 but have now been pushed forward to the beginning of 2016. This gives you time to prepare your testimony. But if you have it ready you don’t need to wait, you can write it on Section 27’s Facebook page or send an email to the commission at ccsa@compcom.co.za.