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Medical Schemes: Are We Getting What We Are Paying For?
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Members paid R40 billion for medical expenses not covered by their medical schemes in 2023. About 2 000 members complained about these denied claims and other medical scheme issues, according to the Council for Medical Schemes. The medical scheme regulator found in favour of more than 50% of those who complained, resulting in many members' claims being paid, or paid more fully. TT is in conversation with Health Funders Association Chief Executive Officer Thoneshan Naidoo and Council For Medical Schemes, Senior Manager For Benefits Management Mondi Govuzela.
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