It was recently announced that two medical schemes will be liquidated in terms of Section 53 of the Medical Scheme Act, due to poor financial performance. Both these schemes are being liquidated at the same time and furthermore they share the same administrator. Now isn’t that interesting?
Where does that leave the members?
The member is responsible for settling the service provider's account if the medical scheme does not pay it.
The question now is, do you pay the hospitals, doctors and other medical service providers accounts and try to claim it back from the medical aid? Will the Medical Scheme refund you or does liquidation absolve the Scheme from paying anything?
That brings us to the next question. If the scheme does not pay the claims and the member does not pay the accounts. The members are being summoned and being blacklisted. Are there no checks and balances, laws etc in place to protect the member as well as the service provider?
For example, a member needs a surgical procedure which requires hospitalisation. He or she gets an authorisation code from the Scheme and goes ahead with the procedure. Three months later the hospital, anaesthetist and pathologist start sending the member the accounts as the medical scheme has not paid the accounts. Six months down the line the member finds himself/herself in debt with long overdue medical bills.
Anyone in this situation?
Let’s have your comments.
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