01 Aug Gastroscopy and colonoscopy costs: What medical aid misses
Posted at 07:00h
in Uncategorised
If you’ve recently been referred for a scope, or if you know you might need one, you need to read this. Currently, we can say with certainty that in South Africa there is a lot that doesn’t get covered by medical aids and the cost of private healthcare is ever-increasing. So, if you are hoping to receive care in a hospital or a consulting room for your colonoscopy or gastroscopy, you need to know that you might have to cover some of the bills yourself. The truth is that your medical aid likely won’t cover the whole cost.
Why does a scope leave you with a bill?
When your medical aid says “pre-approved”, it doesn’t mean “fully covered” and, when it comes to procedures done in the doctor’s rooms that cover quickly dwindles, especially for in-room scope shortfalls. Often, a scope is done in a specialist’s room, not a hospital, and this changes how cover applies quickly leading to a potential in-room scope shortfall.
When it comes to gastroscopies and colonoscopies performed in a GP or specialist’s rooms, you really must consider what your medical aid actually covers. The reality is that specialists are legally allowed to charge well above the medical scheme tariff leading to gastroscopy and colonoscopy medical aid shortfalls. This means, specialists charge what they want, medical aids cover what they want, they are seldom the same and the difference? It’s all yours to pay. This is not the patient’s fault. It is a shortcoming of how private healthcare is priced and can lead to shortfalls you didn’t expect.
What does GapCover actually cover in this case?
If you take out a GapCover policy to protect yourself from the potential financial shortfalls associated with having a colonoscopy or gastroscopy, you are covered for up to two scopes per beneficiary per year. That means an initial procedure as well as a follow up should another be required.
Financial protection to us looks like sending the patient-portion of the bill (a recent client got R14,050.69) directly to your bank account after you claim for a R19,000 colonoscopy your medical aid didn’t fully cover. It could look like months of other expenses you don’t need to find the budget for because you didn’t need to pay thousands of Rands out of your own pocket. And why? Because you took out a GapCover policy.
Who should be paying close attention?
Quite simply, anyone and everyone who sees a colonoscopy or gastroscopy in their future. This is especially true for those who have a family history of colon cancer or digestive conditions and want to take their health and preventative care seriously. It’s better to know and why not add that extra peace of mind that you are covered financially for either procedure with a GapCover scope benefit?
Closing thoughts
When the medical aid pays only a fraction of the bill, it’s easy to panic. That’s the bad news. The good news is that there is something you can do about it. Financial protection from medical aid shortfalls is available to all South Africans on a registered medical aid when they sign up for GapCover.
GapCover’s scope benefit pays what your medical aid doesn’t for gastroscopies and colonoscopies performed in specialists’ rooms, so you don’t have to find the money elsewhere. Sign up today and get the financial protection and peace of mind you deserve.
GapCover provides cover for shortfalls on gastroscopies and colonoscopies performed in a GP or specialist’s rooms, limited to 2 scopes per beneficiary, per annum.