Insurance for Unexpected Medical Bills – Make Sure You Stay Covered

When you think your medical aid pays all your medical bills, think again. Stay covered with insurance for unexpected medical bills.

For instance, Mr Jones, when contacted by debt collectors about an outstanding medical bill, he got the fright of his life.



The bill had remained unpaid for years. Jones was under the impression that medical aid had already settled his bill.

The bill was for an anaesthetist. Mr Jones had not dealt with the specialist directly.

However, it was upon requesting from the debt collector for more information about the debt that he unearthed the truth about his debt.

insurance for unexpected medical bills

Insurance for Unexpected Medical Bills in South Africa

Medical bills and the first rumblings of trouble

Mr Jones did not remember anyone contacting him prior of the unpaid debt. At that time, he had told them what he perceived to be correct about the debt. He understood that the medical aid had settled the bill in full and thus he had no debt.

After all, the medical plan had authorised the surgery and made no mention of any rejection or pending debt thus Jones considered the matter closed.

So why only now?

Mr Jones wanted to know why it had taken so long for them to contact him concerning his debt. He was rather concerned that the medical aid had not received the bill or something of the sort. However, the medical aid had been given the bill but only paid just a portion of the bill related to standard medical aid tariffs and omitted the rest.

What is the responsibility of the medical aid scheme?

The contract with the medical insurer sets out the rules and regulations for payment.

However, it is the responsibility of the patient to ensure the claims arrive on time. Additionally, patients should also get information from the medical aid of the portion of his/her bill that remains unpaid.

However, members of insurance for unexpected medical bills schemes should not assume that if payment is made according to the rules set, they have little recourse against them. Besides, the period between since the first claim would make a new claim invalid.

What is your legal responsibility?

Speaking from a legal point of view, it the duty of a patient to any shortfall. However, there is a slight difference of Mr Jones since no one informed him of the deficit.

However, since a lot of time has elapsed between the first invoice and the steps taken to recover the money, there is a credible case of non-payment of the debt under the law.

Though this is not always the case, one cannot use the passage of time as a defence.

They allow debt non-payment when three years have elapsed since the last attempt to collect the debt.

The debtor should have given consent of the debtor made payment arrangements regarding the debt within the three years.

The borrower should prove that they were not of the debt and the creditor should show the reasonable measures they took to recover the debt.

If the creditor applied for a decision within the agreed time, the debtor should not claim the three-year clause defence.

However, in this case, Mr Jones could be lucky and let off. Not all accounts department is as the remiss as this one.

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All info was correct at time of publishing