Protect Yourself Against Hospital Co-Payments

Medical schemes have increasingly encouraged their clients to user their preferred providers. Such, a trend greatly benefits the plan provider since they can control and anticipate their expenditure. This benefit a client gets is they do not need to make any hospital co-payments. But what is a hospital Co-payment?

Hospital Co-payments

Overcoming Hospital Co-Payment Problems

Going Outside the Network

When you want to see a specialist outside your preferred network, what happens? Previously you would be required to pay the difference between what you are invoiced and what the preferred provider would charge.


Since it means paying quite high hospital Co-payments, then that is the answer to your question. With some instances this accounting for 40% of the bill.

What is a hospital Co-payment?

In simple terms, what medical insurance providers are doing is forcing you to use their preferred provider network. And who has the extra money to pay for high co-payments when it comes to high-end hospitals?

Is it legal?

Legally speaking, they may insist that you should visit their preferred provider in all, but in most exceptional cases, there are minimum procedures prescribed by law concerning the matter.

The minimum benefits pertain to medical emergencies and do not include conditions that could decrease your quality of life or become chronic.

Do your research

You should always conduct your research and find out the preferred service providers before signing the medical plan. It will also benefit you greatly to know the hospital Co-payments applicable should you choose another provider outside your network.

However, in some unique cases, a doctor might consider lowering the rates to minimise your out of pocket expenses.

Nonetheless, this might not be applicable as the medical scheme might still impose the co-payment.

Problems with Medication

The co-payments might not just stop at the doctors’ fee, but it might apply to prescribed medicine.

That gets problematic when the doctors prescribe drugs that the medical scheme does not include in the list of allowed medications. Thus, this could translate to paying for more for the medication from your pocket.


Medical Gap Cover for Medical Scheme Members


Preferred provider to keep costs down

The reason behind having service providers is to help health insurance providers to mitigate their costs. They also design this to ensure that clients have equal access to health care. Further, they intend to prevent clients from visiting hospitals that charge way beyond the standard medical aid rates.

Potential problems for Patients

Visiting the preferred could not always be convenient to patients since this could translate travelling a long distance to get the required assistance.

Additionally, it may also mean that clients start visiting a new set of doctors.

Protecting yourself against hospital Co-Payments

One of the best ways of protecting yourself is getting prior knowledge of a medical scheme before subscribing to one. Researching ahead of time saves you from getting into unnecessary inconveniences, for instance becoming involved with huge co-payments.

Thus, if you are visiting a new doctor, or get medicine from a new pharmacy, always make a call to your insurance provider first, to get to know what co-payments apply.

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All info was correct at time of publishing