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In recent years, medial aid members have experienced steady increases in their monthly contributions as the industry battles against the increasing cost of claims. A huge percentages of these costs can be attributed to fraud. That is one of the reasons why medical aid provider Polmed have recently launched a renewed crack down on fraud.
Fraud can deplete the funds that are available to payout on legitimate claims made by Polmed medical aid members, and that is something that Polmed are seeking to avoid so that members are not faced with higher contributions and fewer benefits. One of the steps that Polmed are taking is to try and educate their members on how they can personally help prevent fraudulent claims. In a recent newsletter sent to all Polmed medical aid members they offered the following tips for prevention and detection of fraud:
Be sure to carefully compare the actual medical care you have used to the services which have been charged and report any discrepancies.
Never allow service providers to use your medical aid card to claim any services that are not healthcare related.
Be sure to be 100% truthful on all claims, falsifying any information is classed as fraud.
There are a number of different things which can be considered as fraud including pretending to be someone else in order to receive healthcare, lending someone your identity documentation including a medical aid card, using someone else’s medical aid card and making any kind of untruthful statement with the goal of getting medical care or pharmaceuticals.
Fraud is a very serious criminal offense and it is something that Polmed are taking very seriously. Any Polmed medical aid members who are discovered to have done anything which defrauds the scheme will face some very stiff penalties as well as a potential custodial sentence. Polmed have reiterated the fact that they operate a zero tolerance policy in regards to fraud and the company have now implemented a very solid task force which has the sole purpose of combating health care fraud. The task force can be contacted on 0800 200 564.
Prevention & Protection Tips
If you are a Polmed medical aid member, or a member of any medical aid scheme for that matter, you can follow these tips to both prevent and protect yourself against health care fraud.
Never give out your membership number to anyone except your doctor or health care provider.
Never give out your membership number over the telephone.
Treat your medical aid card as you would your credit card – it is just as valuable.
Use your personal health care journal or any other diary to record all of your health care including appointments, therapies and pharmaceuticals used.
Review all claim statements for discrepancies, asking yourself these 4 basic questions each time :
Did you receive all of the treatment listed?
Did your doctor order any tests or products listed?
Have you been billed for treatments multiple times?
Is the service listed relevant to your condition?
With a little care and vigilance it is possible for you to help prevent health care fraud, which costs up to R13 billion every single year. With every rand which is claimed fraudulently the risk of legitimate claimants not getting the treatment they desperately need increases, so it is something that needs to be stamped out.
Transmed is one of the many private medical aid programs which medical-aid.co.za can provide you a quote from. Transmed medical aid have a huge range of health care related services which is one of the reasons that they are considered to be one of South Africa’s premier medical aid providers. One of the key selling points for Transmed is that their policies offer a large range of benefits which can be extended to the primary member’s immediate family.
A Closer Look at the Transmed Medical Aid Program
The main focus of Transmed medical aid programs lies in taking into consideration the people who require the medical coverage. One example of this is the fact that when members are signed up via their employer, even in the event of them being terminated due to disability, ill-health or retirement the deal agreed with Transmed will still apply. This means that even if updates are made to the plan after the member’s employment is terminated, the new benefits will still apply.
As noted, Transmed offers a range of different medical aid plans to their members. The three most popular Transmed medical aid plans are:
State Plus Network
State Plus Own Choice
Private Network Saver
The State Plus Network plan can offer members a wide range of benefits including the day to day services of clinics and physicians and will allow for hospitalization in either State enhanced or basic medical facilities, while the State Plus Own Choice plan will also allow for state owned medical centers.
If a member prefers to opt for care in a private hospital, then they can do so, but only if the hospital or clinic is one of the Transmed Private Hospital Network. However, acceptance can only occur if admittance to such a facility can be considered involuntary. For instance, if the required treatment is only available at a private facility. This can include both planned treatment and emergency care.
Managed Care Programmes From Transmed
Transmed medical aid also offers managed care programs designed for the over 60’s. One such program is the Eldercare system which offers support not only for the elder,but also for their family members. Eldercare promotes ‘healthy aging’ and will allow members to become further educated in dealing with the illnesses that commonly affect older people. In addition to the Eldercare system, Transmed also offer HIV care programs and Oncology care. These managed care programmes are intended to help members find the most appropriate treatment and care as well as support them in living a normal life as much as is possible.
You may be wondering why having medical aid is so important? Well if you do not have the means to pay for private medical treatment then you are going to have to look at the alternatives. When you do not have a medical plan, you are leaving yourself vulnerable to problems that can arise when you either fall ill or become the victim of an accident that causes significant injury. Without a coherent medical aid plan, such as those offered by Liberty Medical, you are left with not many options. One of the options is to make use of the state funded medical facilities that are provided by the South African government.
Going to a private medical facility and expecting them to treat you is not going to happen if you do not have a medical aid plan in place, and you may well end up having to take out a loan in order to pay for the treatment you receive. All this will do is put you into debt, which is not something that most people would want to contend with, when they are trying to recover their health after illness or injury.
The option that involves relying on the state run health centres is again not a very suitable solution for everyone. This is because the standard of treatment that you can expect to receive in one of the state run medical facilities may not be up to the standards that you were expecting. The health centres can be overcrowded and underfunded and the waiting times have the potential to be enormous, leaving you waiting, weeks or months for adequate treatment.
Because there are so many medical aid providers all offering a multitude of differing medical aid packages, then it can be a bit difficult to negotiate your way through the maze of different policies and levels of cover that they provide.
If you are young, single and of good health, then you may be just looking for a plan that covers you for a stay in hospital, for when the unexpected happens. However, if you are suffering from a chronic illness and you require long-term treatment, then you will need to look for a policy that is more expensive, but which provides you with more comprehensive coverage.
There are plenty of medical aid websites available on the internet and most of them will be able to assist you with providing you with a quote for their specific medical aid packages. However, in order to make sure that you find the right medical aid package that best suits your needs, then you need to compare the pros and cons, and not to mention the cost, of a wide range of different plans.
This will help you to make the right decision as you should not rush in to making a poor decision when it comes to your health and well-being. That is why you should take your time to consider what options you have open to you when it comes to medical aid.
Owning a top notch medical aid policy is quickly becoming a necessity in these modern times and trying to locate a medical aid policy that both meets the needs of you and your kith and kin, as well as your budget can be a complicated task. Most people would love to have enough medical cover that covers all of the ailments and medical problems that life can throw at them; however, this is not always the case when you are restricted by a tight budget. There is a plethora of medical aid policies out there at the moment and it can be a very complicated task to match the level of cover with the amount of money at your disposal. For that reason you need to look carefully at the details of each policy and take each policy on its own merits.
South Africa has seen a dramatic rise in the costs of its health care and for that reason, obtaining a cheap medical aid
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policy is the solitary option that most people can afford. It is for the reason that health care costs have risen so much in such a short space of time that many people are turning to cheap medical aid policies to help with the cost of health care for them and there kith and kin. However, before signing up for a medical aid policy, it is important that you make doubly sure that the cover offered meets the requirements of you and your family.
Some people are lucky enough to have a subsidised or even free medical aid policy that is provided by the company that they work for. For example, if you work in the medical profession or for a medical insurance provider, then you can expect to be fully covered. For those who do not work in the health care industry, they may find that the company they work for still offers a policy that can the employee can join. Some of the work based medical aid policies can be dependent on the industry the company works in and may not have the level of cover that you require for you and your family.
When it comes to searching for a personal health care policy you need to consider the crucial factors such as the type of cover that the scheme provides for your money. Another aspect that you may need to look into is the option to either downgrade or upgrade your policy in case there is a major change in your financial position. Most policies allow for an upgrade no more than a couple of times in a calendar year; however, some policies are less flexible when it comes to allowing you to downgrade your policy and if you think that your income may drop in the future it is best if you seek out a policy that will allow you to downgrade without incurring a penalty.
With a bit of time and effort you can find the right medical aid policy that covers you and your family.
It is becoming increasingly common for people to opt out of any type of medical insurance because they are unable to afford the premiums. However, if you should find yourself in a situation where you or a family member is in urgent need of emergency medical care you may find yourself shocked at the cost of treatment. When you consider how much emergency surgery costs, a small monthly premium for medical aid seems insignificant in comparison. Here at medical, we aim to help people find cheap medical aid by comparing schemes offered by South Africa’s leading providers.
Unexpected illness or injury is often something we push out of our minds, assuming that ‘it will never happen to me’, but it can happen. When you are stricken with a terminal disease or involved in an accident which leaves you requiring urgent medical care and possibly even surgery, the financial costs can be astonishing. If you have no medical aid in place you may find yourself in financial ruins as you will be responsible for every medical bill incurred. However, when you have medical aid you get that peace of mind which comes from knowing that at least some, if not all, of those expenses will be covered. So why not change that phrase circling in your mind away from ‘it will never happen to me’ to ‘It’s better to be safe than be sorry’!
When you consider medical aid in this context then it actually does not seem so bad to have to pay that monthly premium. The question is really not ‘should I sign up for medical aid?’, but instead ‘which medical aid program should I sign up for?’ That is where we can be of help. Instead of having to contact a long list of providers and going through the same process to get your quote, we can take a few pieces of information from you and go ahead and do the leg work for you. We will compare cheap medical aidoffers from all of South Africa’s leading schemes and return the results to you allowing you to make a choice that suits both your budget and your personal requirements.
These are the things you need to get started:
Write out a list of what you need from your medical aid provider. This should include family medical history which can give you an idea of possible future issues in your health.
Figure out a monthly budget that you can afford, but don’t be too tight. It is not always a case of cheapest is best. You need to find the balance between affordability and quality. If you do not keep up the monthly payments your cover lapses, but if you go to cheap the cover might be limited.
Be aware that you, or any family member, who has a long term or chronic disease, which might include ongoing treatment and/or expensive medications, may be liable for an additional premium.
With this information in mind and our online quote finder, you should be able to find the medical aid that is right for you. Be sure to take time to consider the results and do not simply opt for the lowest of the quotes. In some cases it is worth paying a little extra to ensure that you have a sufficient level of cover.
Having a medical aid scheme is something that everyone needs to have for his or her own health and well-being. Since accidents and illnesses can occur at any time, it is important to have a medical aid scheme to protect yourself from the expenses that may be incurred when they happen. One place where you can get quotes on inexpensive medical aid schemes is www.medical-aid.co.za. By submitting the requested information on the site, you will be emailed a number of quotes that you can choose from.
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With up to 160 different medical aid schemes offered in South Africa, the process of choosing the plan that is best for you can be daunting. With the free quotes offered at Medical Aid, the process of finding the medical aid scheme that you desire will be made easier. In some cases, employers may offer medical aid rates that are extremely competitive for different medical services provided to you when visiting a doctor.
Additionally, if you or a member of your family suffers from a previous medical condition medications or treatments may be required. By obtaining a cheap medical aid scheme, those medications and treatments will be covered so you do not incur out of pocket expenses that you cannot afford. If for some reason, you or a member of your family gets into an accident and becomes unexpectedly ill and ends up in the hospital, don’t be stuck with extensive medical bills. By taking the time to get the right medical aid scheme you can focus on recovering from whatever ailment you have been afflicted.
Why spend time stressing over how you are going to pay for your medical expenses when you need to focus on your recovery. Being sick or injured is stressful enough, but having to worry about how you are going to pay for your medical bills will make that more difficult. Take the time to do a bit of research on the kind of cheap medical aid scheme you need. Then submit your information into www.medical-aid.co.za and get the quotes that you need to help you find the one that will work best for you and your family.
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Do you have a chronic medical condition that requires daily medication? Are you planning to start a family with your new spouse and want to make sure all of the medical expenses will be covered? Do you simply want to make sure that you and your family are covered in case any of you contract a normal cold or virus? If you want to make sure that your family is covered in the case any sort of illness or accident requires a visit to a doctor’s office or a hospital, then finding an inexpensive medical aid scheme is critical.
Nobody ever wants to think that he or she will get sick or need to spend time in a hospital. Unfortunately, the realities of life show us that people of all ages, backgrounds, and financial levels get sick or have accidents at one time or another. If you are not covered by any sort of medical aid scheme having to spend time in the hospital will be not only physically stressful, but financially stressful as well. At the most important time, when the person in the hospital should be focusing on getting well, they have to consider how they will pay for the medical bills once they are home.
One way to avoid the added stress that comes with emergency trips t
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o the hospital, for yourself or your family, is by researching and finding a cheap medical aid scheme. Medical aid schemes are available at a variety of costs, and in some cases, an employer may offer prices that are even more competitive. By determining what kind of coverage you and your family need, as well as what you can afford to pay, you will be able to find the medical aid scheme that you and your family need to ensure your healthcare needs are covered.
If you need assistance, or would simply like free medical aid quotes to help you find the coverage you need, visit www.medical-aid.co.za today. By providing them with some specific information they will find different medical aid schemes that will be a good option for you and your family.
Health Insurance Forum (Photo credit: Aaron Landry)
Everything in our lives needs to be protected, from our homes to our vehicles and most importantly to our health. Although having no or very basic coverage may result in the loss of your home or vehicle, as devastating as that may be, they can be replaced. For those individuals that do not have some form of health coverage, or those who have the wrong medical aid scheme, there could be serious health ramifications. With the wrong or no medical aid scheme, if individuals have to be hospitalized for any reason, there is a good chance that the individual and their family could suffer serious financial instability.
For individuals living in South Africa that do not have a medical aid scheme, there are many options available. Regardless of your financial situation, or the type of coverage that you and your family require there are options available. There are medical aid schemes that are designed specifically for different groups. Medical scheme providers have created coverage that is specifically for individuals that are young and single, to individuals that are just starting their families.
No matter what your age or your financial situation, there are medical aid schemes that will offer you the benefits that you need and require. One thing that has to be considered before you commit to a medical aid scheme is if the plan you are choosing covers any preexisting conditions and if you will need additional benefits to ensure that your health is covered.
If you are searching for a good medical aid scheme, be aware that there are a number of companies in South Africa, which are offering a variety of plans. Talk to friends and family members to get their input on the experiences they have had with their insurance company. Make sure that when you do decide on a medical aid scheme that you talk to the company providers directly to insure that you are aware of all of the benefits and coverage that the scheme you want offers. With a bit of research and thought, you can find an affordable and quality medical aid scheme for you and your family.
In recent years, medial aid members have experienced steady increases in their monthly contributions as the industry battles against the increasing cost of claims. A huge percentages of these costs can be attributed to fraud. That is one of the reasons why medical aid provider Polmed have recently launched a renewed crack down on fraud.
