Costa Plenty

©2012 Edward C. Lunnon

Tuesday 31 January 2012: 5 years 4 months on … Deuce

Last week I wrote about the grounding of the Costa Concordia in Italy. I read recently that this mishap will become the largest maritime insurance claim ever. Costa Plenty!

Life’s like that!

Just when we think our life’s a cruise, the wind gets taken out of our sails. There’s no plain sailing. And every now and then we end up on the rocks.

Even being ill with one affliction doesn’t preclude one from getting another.

And so the last two weeks have seen a few more rounds of doctor’s visits and more pills and more medication.

Things seem to be getting better slowly – hopefully soon I will be feeling “OK” and will only have the CBD to contend with again. That, anyway, is an exercise of strength and survival. Sometimes, I feel like the captain of that ill-fated ship and wonder if it’s just not easier getting off this ship early – “falling into a lifeboat” as he so vividly described his leaving the ship before many of his passengers.

But for the meantime, I’m here till the end and have to handle what comes my way. And it all “costa plenty”, too.

Last Monday I went for my annual check-up.  The only reason I go for an annual is because I need a specialist report to send to my Insurers to inform them that I haven’t yet had a miraculous recovery. Other than that, I get ten minutes in which I do most of the talking, get a few yawns from the doctor, have my elbows and knees tapped with a silver hammer, flick my fingers and get to pay R500. R500 for 10 minutes equals a R3000 hourly rate. Costa Plenty!

Just as an exercise, I thought I would check around to see what the recommended rates are for such a visit.

I felt a bit uneasy phoning doctors to find out what their rates are. I don’t know why because that’s what we do with any other purchase we make – looking for the best deal. But somehow, we don’t seem to do that with medical services. It’s something that I think we have learned along the way. After all, doctors always do things in our best interest – or do they?

It was quite amusing listening to the responses that I got – from sheer disbelief that I had the audacity to ask such a question to plain rudeness that I even dare ask such a question! And, in between, a few splutters and excuses for not being able to share the tariff list with me. How unusual that anyone should ask such a question and how damn forward of me to even consider making such a phone call!

I then went to the internet to see if I could fare better there. After having googled a few times and coming up with different suggestions of reading material, I discovered that this was no easy task.

Understanding the acronyms, organisations, rules and laws that govern the medical profession in our country would take far more than my diseased brain to understand.

All I realised was that we have another organisation in disarray and that in the meantime we should just fork up and pay. And it would appear that the big guns running the medical industry right now are the medical aid societies. (* See note below)

In fact, the one receptionist told me that her doctor didn’t have a set tariff – it all depended on what the medical aid paid him as to what the charge to me, the patient, would be. It sort of reminded me that if you went shopping for goods at Woolies, the price would depend on whether you were paying by Woolies card, Mastercard or Visa – that your bank would determine the price of the goods you were purchasing.

The bottom line is that it would appear that there is no such thing as a standard tariff – there’s no one price fits all, and if you don’t shop around, you are going to end up paying the maximum! Yip, it “costa plenty” to become ill!

And, as in my case, when I haven’t worked for five years, my ability to earn an income has been curtailed. Taking into account an annual salary 5 years ago of, say, R250 000, a simple calculation and without costing inflation, bonuses, etc, would  highlight that my illness has cost me an income so far in excess of one and a quarter million rand!

Make sure that you have planned for the day when your cruise liner hits the rocks. It’s bound to “costa plenty”!

 * Read this note – I hope you understand it!


08 November 2011

Regulation 8 ruling should prompt new era of tariff negotiation – SAMA

 While welcoming the North Gauteng High Court ruling that Regulation 8 of the Medical Schemes Act (131 of 1998) – that medical schemes must pay in full for all PMB conditions – SA Medical Association (SAMA) chairman, Dr Norman Mabasa, has again stressed that the Competition Commission ruling banning medical schemes and provider groups from negotiating tariffs should be revisited.

“We have spent a lot of time and effort supporting the Council for Medical Schemes (CMS) in its defence of Regulation 8,” said Mabasa when commenting on the ruling which came as a result of the Board of Healthcare Funders (BHF) asking the court to pronounce on it almost a year ago. The BHF was later joined by the SA Municipal Workers Union National Medical Scheme in seeking to have Regulation 8 interpreted to mean that schemes must pay for PMB conditions only up to the scheme tariff, effectively changing the meaning and purpose of the PMB provisions in the Act.

“Yes, it is a victory for the CMS, for those of us who backed the CMS cause, and particularly for medical scheme members, but this is another one of those issues that should never have ended up in court,” Mabasa added.

“This was not a misunderstanding of the PMB rules,” he explained, “but a development that can be directly attributed to absolutely no mechanism being available for providers and schemes to negotiate on tariffs and possible issues surrounding them.

“We hope that the medical schemes will now join SAMA in pushing for a new era when provider groups and funders can engage positively on pricing requirements,” said Mabasa.



One comment on “Costa Plenty

  1. Pingback: Medical Tariffs in SA affected by this court ruling | BrainStorms – Ed Lunnon's Blog

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