Issued by: Cape Medical Plan


The first step in managing health costs is accepting that they can be managed. Then:

1. Accept change
Health care today is commercial. For example, though the purpose of hospitals is health care; their aim, like banks or retailers, is to make a profit for shareholders. We may find this objectionable - what happened to good old-fashioned human concern? It's still there, but so is commerce.
The same applies to doctors, dentists and pharmacists. And their pursuit of profit is the major force behind rising medical costs.

The best way of managing your health costs is to separate transactions with providers from issues of health. Key questions are “How much?” “What discount do you give for cash?” and “Where's the best price?”

The last may result in your voting with your feet - you may find that the small Main Road pharmacy charges less and is more open to negotiating price than the big shopping centre pharmacist you've always used.

2. Ask “How much?”
Your health comes at a cost and like health, cost has to be managed. And it varies. For example, before you receive a doctor's or dentist's treatment, ask how much it will be. Medical practitioners don't only work for the love of humanity: they are also businesses. If he or she won't, or gets affronted, your feet???????????. You are not in the business of issuing blank cheques.

3. How to negotiate
Many find it embarrassing to discuss money with a doctor or dentist. They fear it suggests that they can't pay and will therefore be looked down on, or people - in a waiting room or in reception - will scorn them.

Successfully negotiating cost with a medical provider involves: picking the right moment, picking the right person, acknowledging the other's position and stating yours clearly.

Scenario 1
You (to receptionist): I'm coming to see the doctor about a procedure and would like to speak to him.
Receptionist: He's very busy. May I ask what it's about?
You: I'd like to know how much the procedure will cost.
Reception: His standard fee for this R500.

This scenario leaves you blocked.

Scenario II:
You: I'm coming to see the doctor about a procedure and would like to speak to him.
Receptionist: He's very busy. May I ask what it's about?
You: It's a confidential matter that I'd like to discuss with the doctor. When would be a good time to phone?

You assert your privacy and your right to speak to the doctor. If the receptionist continues blocking you, play what is called “Stuck Record:

You: It's a confidential matter that I'd like to discuss with the doctor. I understand he is very busy; I'd like to speak to him. I'm sure he could call me between patients.

Avoid a power struggle. The receptionist is doing his or her job. But you have a need and a right.

Scenario III:
You and the doctor
You: Doctor, you suggested I come in about a treatment. I need an idea of its cost before I have it.
Doctor: Oh, it'll be quite reasonable.

The doctor may be embarrassed or may not be taking you seriously.

You: I'm sure it will. (Acknowledge his good faith the acknowledge emotions.) This is embarrassing for me and may be for you but I do need to plan my finances so could you give me a figure, please?

Doctor: It'll be about R400.

OR

Doctor: I really can't say. It depends on what I have to do.

Comment: This may be reasonable but it doesn't meet your need. Your choices are:
To say: “I'd like to keep the appointment pending my medical aid's advice.”
To act: Ask Cape Medical Plan about the cost of such procedures.

You say: “I need to plan my finances and it looks as though the information I need isn't available. I'd like to find out more and meantime postpone the appointment.”
Action: Ask CMP to recommend another doctor.

Scenario IV: Paying cash
You: Doctor, I'm having this procedure which you said would cost about R400. Do you offer a discount for a cash payment?
If the doctor says yes, great. If not, you have to decide what this says about your relationship with the doctor and what it means to you financially. Your options are to live with it, or to vote with your feet.”
Cape Medical Plan can advise you about alternative doctors.

4. Hospitals
Going into hospital is, for many, like their first day at school for small children: scary. It involves a strange environment and giving up control. To the traditional fear factors of hospital, is added another factor: cost.
Cape Medical Plan can guarantee your hospital access when you need it. In an emergency, one phone call to 0219378300 - day or night - will secure this.

a) State facilities
State facilities - hospitals and clinics - some do offer quality treatment. Phone Cape Medical Plan at 0219378300 for a list of the facilities near you. And you can claim back the costs of using these from us.

In the case of an emergency only ie. a matter of life or death and if the condition is a PMB we will settle this from your insured benefits, however if it isn't it will come out of your Medical Savings Account, or your own pocket.

5. Pharmaceuticals
There are two main ways of managing the cost of pharmaceuticals. One is to shop around.

What your pharmacy charges may reflect the cost of its location and surroundings. Large pharmacies in shopping centers have high rents and staff costs thus their prices are usually higher than simpler or humbler ones.

i) Ask the pharmacist whether the medicine you have been prescribed is available over-the-counter ie. it's not a scheduled drug, which requires a prescription. If it is, this means that you would pay the pharmacist a lower dispensing fee. In other words with a prescription you will pay a dispensing fee of 26%, without a prescription (Schedule 1 and 2 drugs) you will pay 16% and for over the counter medications ie. Schedule 0 and 99, you will not pay a dispensing fee.

ii) The administration fee of pharmacies varies from pharmacy to pharmacy, so shop around.

iii) Is there a generic equivalent available? Pharmaceutical companies produce medication whose cost reflects research and development. When their patents lapse, other companies recreate them and sell them more cheaply though they have the same quality. Ask your pharmacist about generic equivalents.

iv) Ask the pharmacist what cash discount he or she gives.
Discounts are illegal, however you can earn points on a loyalty program on the dispensing fee, but not the cost of the medication.

Visit our PRESS OFFICE: Established in 1961, Cape Medical Plan combines 40 years of time-proven experience with 21st century technology. Cape Medical Plan has designed its new generation Medical Scheme for South Africans who want to play an active role in managing their family's health and wellness.- more....

[1 Mar 2008 15:54]

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