I think it is pathetic for a medical aid to pay only R13330 for a knee, hip or shoulder replacement when pre-authorised. ALL other costs are for the patient, regardless of the fact that "hospitalisation" is covered for 100% contracted tariff - it EXCLUDES knee, hip and shoulder replacements! The prosthetic alone costs R45000. This means the patient needs to pay for two thirds of the prosthetic, the full cost of the surgeon, the anaesthetist, the ward accommodation, all treatment, medicine and ward fees. My conclusion is that it will be better for him to fall and break his knee to have an emergency knee replacement, than to have it done with pre-approval. It does not make sense to pay a monthly fee of R2700 and then to have to pay R70 000 before a knee replacement is even done!!! Does the medical aid rather want to pay pain killers (and the consequences of that to his health) and a wheelchair for the rest of the patient's life? Worst of all: it is a loyal member who has been a member since 1968!!!
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