Streaming issues? Report here
CapeTalk Logo CapeTalk Logo
volume_up
volume_mute


Home
arrow_forward
Business
fiber_manual_record
Lifestyle

Even cheapest medical aids must pay for treatments not offered by state - Court

18 February 2020 12:45 PM
Tags:
Insurance
Discovery Health
Medical aid
Personal finance
Kieno Kammies
Prescribed minimum benefits
Council for Medical Schemes
Medical insurance
medical schemes
Thembekile Phaswane
Tim Modupe
PMBs
medical costs
Consumers may now force their medical aids to fund any drug or medical care a doctor considers necessary to treat any PMB disease.

It’s almost as if they [medical schemes] set the whole thing up to create all these hoops and loops to jump through so that they don’t have to pay.

Kieno Kammies, presenter - CapeTalk

A court ruling has empowered consumers to force their medical aids to fund any drug or medical care a doctor considers necessary to treat any disease that falls under the “Prescribed Minimum Benefits”, a basic basket of care.

Discovery Health Medical Scheme lost its case over its refusal to pay for a member’s glaucoma implant, despite a specialist recommending the operation.

The scheme, which would have paid for treatment twice the cost of the device, argued that clinical evidence around the implant was weak.

It also argued it was legally entitled to refuse payment for the device because it was not available in state hospitals.

The industry is now compelled to pay treatments not offered by the state if recommended by an appropriate medical professional.

Kieno Kammies interviewed Thembekile Phaswane (Senior Manager, Council for Medical Schemes) and Dr Tim Modupe (Head of Clinical, Council for Medical Schemes).

This case doesn’t just open floodgates. You look at clinical appropriateness of the treatment… in this case, it was founded that the recommended treatment was effective…

Thembekile Phaswane, Senior Manager - Council for Medical Schemes

There needs to be a comprehensive preventative and primary healthcare component to future PMBs… to help us discover illnesses earlier when they can be treated more effectively and for cheaper…

Dr Tim Modupe, Head of Clinical - Council for Medical Schemes

For more detail, listen to the interviews in the audio below.

Subscribe to our Business Wrap Newsletter


18 February 2020 12:45 PM
Tags:
Insurance
Discovery Health
Medical aid
Personal finance
Kieno Kammies
Prescribed minimum benefits
Council for Medical Schemes
Medical insurance
medical schemes
Thembekile Phaswane
Tim Modupe
PMBs
medical costs

Recommended

More from Business

Piggy bank mask covid-19 coronavirus 123rfbusiness 123rflifestyle 123rf

'If you still have a job, get rid of your debt as fast as you can'

2 April 2020 8:04 PM

Personal finance expert Warren Ingram has advice on how to survive – or even thrive – amidst the Covid-19 outbreak.

Share this:
Read More arrow_forward

Sorry we closed small business 123rfbusiness 123rf

Covid-19: Struggling to pay - or collect - the rent?

2 April 2020 7:37 PM

The Money Show's Bruce Whitfield interviews property lawyer Julian Scher about rental payment problems caused by Covid-19.

Share this:
Read More arrow_forward

candle-dark-electricityjpg

Eskom is making the best use of the crisis - André de Ruyter, CEO

2 April 2020 6:50 PM

The Money Show’s Bruce Whitfield interviews Eskom CEO André de Ruyter about the utility’s plans during the Covid-19 lockdown.

Share this:
Read More arrow_forward

race-unity-hands-harmonypng

'Thousands of ordinary South Africans have contributed to the Solidarity Fund'

2 April 2020 6:34 PM

It's an enormous humanitarian effort. Bruce Whitfield interviews Dr Adrian Enthoven, Deputy Chairperson at the Solidarity Fund.

Share this:
Read More arrow_forward

191119-saa-edjpg

German nationals heading home as SAA agrees to repatriate foreign citizens

2 April 2020 1:52 PM

South African Airways (SAA) has agreed to provide repatriation charter flights to various international destinations.

Share this:
Read More arrow_forward

Minibus taxi commuters disembark Johannesburg transport 123rflocal 123rf

'100% occupancy risks lives of people over money and we support 70%' - Santaco

2 April 2020 1:22 PM

National Santaco spokesperson Thabiso Molelekwa insists it never supported the 100% passenger occupancy of minibus taxis.

Share this:
Read More arrow_forward

180529taxi-delftjpg

It's high time the minibus taxi industry is subsidised, says Santaco WC chair

2 April 2020 11:34 AM

The SA National Taxi Council (Santaco)'s Western Cape chairperson Nazeem Abduraman says the industry must be subsidised.

Share this:
Read More arrow_forward

Empty conveyor production economic crisis covid-19 123rfbusiness 123rf

Employers urged to apply to UIF Covid-19 benefit fund for employees

2 April 2020 10:57 AM

UIF will transfer the funds to the company and they are able to pay employees digitally explains UIF Commissioner Maruping.

Share this:
Read More arrow_forward

Empty office space covid-19 coronavirus lockdown 123rfbusiness 123rf

Lockdown labour regulations explained

2 April 2020 8:39 AM

What workers should take into consideration when it comes to having to take leave during the lockdown period.

Share this:
Read More arrow_forward

car insurance short-term cover 123rfbusiness 123rflifestyle 123rf

No traffic and everyone’s at home… Some short-term insurers offer lower premiums

1 April 2020 7:38 PM

Short-term insurers suddenly carry a massively reduced risk burden, says consumer journalist Wendy Knowler. Getting some back?

Share this:
Read More arrow_forward

More from Lifestyle

Piggy bank mask covid-19 coronavirus 123rfbusiness 123rflifestyle 123rf

'If you still have a job, get rid of your debt as fast as you can'

2 April 2020 8:04 PM

Personal finance expert Warren Ingram has advice on how to survive – or even thrive – amidst the Covid-19 outbreak.

Share this:
Read More arrow_forward

Sorry we closed small business 123rfbusiness 123rf

Covid-19: Struggling to pay - or collect - the rent?

2 April 2020 7:37 PM

The Money Show's Bruce Whitfield interviews property lawyer Julian Scher about rental payment problems caused by Covid-19.

Share this:
Read More arrow_forward

photo-1534859563435-852a491d410cjpg

Black dog syndrome: #ThePawcast's Lauren Palmer explores the phenomenon

2 April 2020 7:09 PM

Black Dog Syndrome is a phenomenon in which black dogs are passed over for adoption in favour of lighter-coloured dogs.

Share this:
Read More arrow_forward

race-unity-hands-harmonypng

'Thousands of ordinary South Africans have contributed to the Solidarity Fund'

2 April 2020 6:34 PM

It's an enormous humanitarian effort. Bruce Whitfield interviews Dr Adrian Enthoven, Deputy Chairperson at the Solidarity Fund.

Share this:
Read More arrow_forward

plain-package-cigarette-smoking.jpg

Good news for smokers: Western Cape to resume sale of cigarettes

2 April 2020 1:18 PM

Premier Alan Winde says it is not so much the lifting of a ban, as a re-interpretation of lockdown regulations.

Share this:
Read More arrow_forward

radio-garden-1png

The Radio Garden app uses Google Earth-style map to connect 1000s of stations

2 April 2020 12:42 PM

Enchanting idea has a map-based website with radio stations across the world, including CapeTalk, connecting the world's cultures.

Share this:
Read More arrow_forward

cheyne-morrisby-cooking-demopng

Join live cooking demos to support Cheyne's Restaurant staff during lockdown

2 April 2020 12:02 PM

Cheyne Morrisby has adapted his business to help keep his 80 staff members afloat during the Covid-19 financial crunch.

Share this:
Read More arrow_forward

car insurance short-term cover 123rfbusiness 123rflifestyle 123rf

No traffic and everyone’s at home… Some short-term insurers offer lower premiums

1 April 2020 7:38 PM

Short-term insurers suddenly carry a massively reduced risk burden, says consumer journalist Wendy Knowler. Getting some back?

Share this:
Read More arrow_forward

covid-19 coronavirus economy 123rfbusiness 123rflifestyle 123rf recession

What is an 'economic depression'? Are we heading for one? Lessons from history…

1 April 2020 7:09 PM

The Great Depression started 91 years ago and changed everything. Bruce Whitfield speaks to economic historian Keith Breckenridge.

Share this:
Read More arrow_forward

household-bills-debt-expenses-money-finances-black-young-couple-worried-123rf

Struggling to pay a debt? Your options: credit insurance vs debt relief holiday

1 April 2020 6:29 PM

Personal Finance expert Maya Fischer-French on the pros/cons of dipping into credit insurance vs opting for a debt relief holiday.

Share this:
Read More arrow_forward