Scopes, Scans and Tests on Hospital Cover

When you decide to take out medical aid cover it is because you’ve thought about what the costs of doctors and specialists would be. You wonder what surgery would cost if you were to land in hospital and what it will cost every day in hospital. A stay in hospital may well include expensive diagnostic procedures such as colonscopy, CT scan, MRI (magnetic resonance imaging) and others as well.

Most time these sort of outpatient procedures may be paid for from the day-to-day benefits, but those on hospital plans will likely have to fork up and pay themselves. These procedures are expensive and costs several thousands Rands. Just think of the range of diagnostic investigations you get – as scopes and scans and different tests that are required to diagnose diseases. The expenses of these can be financially crippling if you are not prepared. In fact just one single MRI scan  can be equivalent to you spending about 3 days in a private hospital.

Scans Scopes Tests – Know what your Hospital Plan Covers

Scopes Scans TestsA medical aid comes with different benefits for different procedures. People wrongfully assume that just because they are having certain tests carried out in a hospital, their hospital benefit cover simply deals with these costs. There is often quite a bit of confusion surrounding what medical aids will cover and what hospital  plans will cover.

If you have hospital cover, you can expect your hospital stay, your treatment from your doctor’s fees as well as the surgery and certain treatments that you might receive to be covered. Other tests, scopes and scans might also be covered if it is treatment that is required for the disease that put you in hospital.

Bear in mind that there are certain factors that you need to consider. For instance, did your illness require you to be hospitalised? Maybe the hospitalisation was only for further testing, scans and scopes.  Your medical aid might only cover your illness-investigation from your day-to-day benefit savings. Do you have the benefit of day-to-day cover? You will need to have the funds available for the investigations. If you are not on a medical aid scheme but a hospital plan, you may not be covered.

Scans Scopes Tests – Get Clarity on what Tests are Covered

You need to always verify with your scheme whether testings, scans and scopes, etc. are covered for payment. This is because there are plans which allow patients to be hospitalised for a procedure recommended by the doctor. However, the medical aid industry is having to cut costs and they have been forced to implement tougher restrictions. This means that some of the lower plans won’t allow for these procedures to be paid from the hospital plan.

Even if you have day-to-day benefits and the costs of the procedures cannot be fully met by these benefits, your scheme will not pay the remainder from your hospital cover. You will have to make up for the shortfall in cash.

The responsibility lies with you to check what cover you will receive for any procedures. The private hospital or your doctor are not responsible if your medical aid won’t pay for testings, scans and scopes, etc. This will avoid you receiving a surprise heavy medical bill after all the tests are concluded.

Scans Scopes Tests – Don’t Just Assume you are Covered

Just because certain tests occur in a  hospital does not guarantee that they are covered by your medical aid. If your doctor wants to proceed with tests as part of your illness-investigation, ask him or her if the costs are part of prescribed minimum benefits. It will be up to the medical aid to decide whether the testings are necessary or not.

Be prepared – don’t be caught off guard because you did not do your homework to find out where you stand precisely with your medical aid or hospital benefits.

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