Not so! The rate at which Medical Schemes pay for in-hospital procedures and the rate at which the service providers charge are two worlds apart.
Medical Schemes fund claims at a Scheme Approved Tariff, whilst Medical service providers usually charge for their time and expertise at a rate far in excess of the Medical Scheme Tariff.
More often than not, there will be a short-payment on your in-hospital procedures account, due to the General Practitioner or Specialist charging in excess of what your Medical Scheme covers. This can in some cases be as much as two times the Scheme Tariff.
Depending on the nature and length of time of your in-hospital procedure, this short payment could be a fairly significant amount, leaving you the member significantly out of pocket.
This product is designed for in-hospital procedures, to “fill the gap” between what is charged by your service provider in-hospital and what is covered by your Medical Scheme. The actual benefit paid is subjected to a maximum(up to two times the Scheme tariff) as per the brochure. Should your service provider charge in excess of this, then you would still be liable to cover this additional amount yourself. It is always advisable, wherever possible, to negotiate and confirm the best possible rates with your service provider to avoid excessive patient liability.
Should you wish to apply for this Gap Cover, kindly complete a Complimed application form and fax it to Momentum TYB on the fax number (041) 395 4590. Momentum TYB will collect the R75 per month from your payroll or via debit order where applicable and pay it across to Complimed on your behalf. Momentum TYB will also assist you with the claiming process once you have been hospitalised.
Should you wish to find out more about this product or to obtain an application form, please feel free to contact the Medimed Customer Care team on (041) 395 4474.