Many times, you will make an appointment with a medical practitioner and find out that the doctor is contracted out of medical aid. This usually brings a feeling of dread because you know that their fees are probably higher than the amount your medical aid is willing to pay for their services.
If the fees that your doctor charges for in-hospital treatment are above and beyond what your medical aid pays, you will have to pay the difference. This gap between what the doctor charges and what the medical aid pays may not be significant in all instances, but it can quickly add up if you were involved in a serious accident, for example, and require medical treatment in hospital.
When a medical practitioner is contracted out of medical aid, then you usually need to take care of the administration involved with claiming the money from your medical aid yourself. If the medical practitioner is contracted within medical aid, then they generally claim the fees directly from your medical aid.
It seems like an obvious choice to only use medical practitioners that are contracted within medical aid, but unfortunately this isn’t always possible. Proximity, areas of specialisation and many other factors come into play when choosing a doctor. If you are worried about paying the difference between medical aid rates and private rates for in-hospital treatment, then you should start investigating gap cover solutions. This type of medical cover insurance will foot the bill between what your medical aid is willing to pay and what your doctor is charging. Find out more about medical aid gap cover.
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