Most people assume that if they have a medical aid, they will be covered for all in-hospital expenses. Unfortunately, this is not always the case. Doctors and other service providers in private hospitals are not employed by the hospital and their fees are not regulated- effectively they can almost charge as they wish to a certain degree.
Furthermore, if you phone your medical practitioner and find out that they do not have an agreement with your medical aid, their fees are likely to be higher than the amount that your medical aid is willing to pay.
When it comes to in-hospital treatments, if your doctor’s rates are higher than what your medical aid will pay, you will then have to pay the difference yourself. This gap is not always that large, but it can get costly, especially if you have had a more complicated procedure.
It would make sense for you to choose a medical practitioner which is contracted within your medical aid, but that is not always possible. This is extremely difficult when it comes to specialised doctors. If you are worried about paying the difference between the doctor’s rates and the medical aid rates, then you need to look into investing in a Gap Cover policy.
Gap Cover is a short-term insurance product which covers the gap between the medical aid rates and the doctor’s rates for in-hospital expenses. You can find out more about TRA Gap Cover by clicking on the link below: