29 Oct Back and neck procedures can cost you thousands. GapCover closes the gap.
If you’ve ever suffered from serious back or neck pain, you’ll know it can be completely life-altering. Unfortunately, so can the medical bill.
From spinal fusions to shoulder repairs, these procedures are among the most expensive in private healthcare. And while your medical scheme might cover part of the cost, it’s the unexpected shortfalls that often leave patients shocked.
The true cost of back and neck procedures in private healthcare
Let’s talk real numbers. These are average amounts charged by private practitioners and what you could be paying out-of-pocket without extra cover:
| Procedure | Amount Charged by Practitioner | Potential Shortfall (Payable by GapCover)* |
|---|---|---|
| Back Fusion | R87 633.53 | R65 675.32 |
| Shoulder Operation | R56 450.88 | R42 317.19 |
| Joint Replacement | R102 673.15 | R74 284.70 |
*Based on historical claim data. Actual shortfalls may vary.
That’s tens of thousands of rands in co-payments and they often come as a surprise, especially when you thought your medical aid had you fully covered.
Why your medical scheme might not be enough
Your medical aid pays doctors and specialists based on a specific medical aid rate (also known as a tariff). But here’s the catch: many private practitioners charge up to five times that rate.
That difference between what your scheme pays and what your doctor charges is called a tariff shortfall, and that’s where cover like GapCover steps in.
Think of it as a safety net: it’s not a replacement for medical aid, but it protects you from the costs that your scheme doesn’t pay in full.
Understanding co-payments: The hidden medical expense
Even with planned procedures, co-payments can appear when you least expect them. These are additional amounts your medical aid requires you to pay directly to the hospital or specialist before treatment.
For something like a back fusion, a co-payment of R20 000 or more isn’t uncommon, and that’s before any shortfall on the surgeon’s fees. Without additional cover, these bills can quickly drain your savings.
How GapCover (standalone), Combined, and Elite Cover help you handle the gap
GapCover offers three options designed to meet different needs and budgets:
- GapCover: Ideal if you already have a comprehensive medical aid and simply want protection against shortfalls on in-hospital procedures.
- Combined Cover: Includes both shortfall protection and additional hospital co-payment benefits
- Elite Cover: The premium option for those who want the highest level of protection with benefits of up to R60 000 for shortfalls on in-hospital back and neck procedures.
Elite also includes enhanced benefits for specialised procedures (like spinal or joint surgeries), helping you avoid those unexpected bills that often follow major operations.
Is it worth it? Peace of mind for a known risk
If you’ve ever needed physiotherapy, chiropractic treatment, or back and neck scans, you know how easily those costs add up. Now imagine the bill for a major surgical procedure.
Having the right cover gives you peace of mind, knowing you can focus on recovery rather than repayments. As many members discover, it’s the kind of security no one knew they needed until they did.
How to get cover before you need it
It’s clear that the best time to get protected is long before you even need it. Whether you’re considering GapCover, Combined, or Elite Cover, we suggest you take a moment to compare the options at your disposal and choose the one that fits your lifestyle, wants, and medical needs.
Your back, and your wallet, will surely thank you later. Compare or upgrade your cover today.
Call now for a quick GapCover quote: +27878200627
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