Raw deal for medical aid members

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MEDICAL aid card holders in Manicaland are getting a raw deal from private health care service providers who are either demanding top-up fees or totally refusing to attend to patients on medical insurance, The Manica Post has established.

In addition, most pharmacies are using parallel market exchange rates for shortfalls charged to medical aid card holders, especially for those on local currency schemes.

This is despite the fact that medical aid members are forking out amounts hovering above ZWL50 000 every month with the hope that their schemes will cushion them in the event that they or their dependants fall sick.

A survey conducted by The Manica Post in the province over the past two weeks revealed that some private hospitals and pharmacies are only accepting US dollars.

The survey revealed that some pharmacies in Manicaland were turning away patients with medical aid cards under the pretext that their machines are offline.

At Manatsa Radiology in Mutare, patients on medical aid are required to fork out some cash, with the officials there highlighting that they do not accept medical aid cards.

At Lancet Laboratories, PSMAS medical insurance is not accepted, while USD is demanded for tests that are done in South Africa.

As of last week, Booties Pharmacy was using an exchange rate of ZWL1 000 per each dollar, way above the official rate.

In Rusape, New Life Medical Centre is accepting all medical aid schemes, while Tariro Medical Centre is accepting all the other schemes, except PSMAS.

Life Care Pharmacy’s Rusape branches only accepts selected medical aid schemes, while Greensview Pharmacy does not accept any medical aid schemes.

However, while some General Practitioners scattered across the province demand top-up fees from medical aid members, a few medical practitioners, even specialist doctors, are content with the payments that come from their medical aid claims.

Eastern Grace Dental proprietor, Dr Tarzen Mugadza said: “We are basically accepting all medical aid cards and payments. There are agreed rates that we use and they are uniform. It is not for us to decide.”

When contacted for comment, Association of Healthcare Funders of Zimbabwe (AHFoZ) chief executive, Ms Shylet Sanyanga said: “Please be advised that the local currency is a legal tender and is acceptable for business transactions in Zimbabwe. It is not justifiable for any service provider to reject payments in local currency and deny access to healthcare services for those in need.

“It should be noted that salaries are predominantly being paid in local currency, hence people can only use the currency that they have,” said Ms Sanyanga.

She said there is no reason for valid medical aid cards to be rejected.

“There is no reason for valid medical aid cards to be rejected. If there are specific challenges, these should be addressed instead of applying blanket rejections as this inconveniences those in need of healthcare services. Furthermore, rejection of a valid medical aid card is against the law.

“The members whose cards would have been rejected should contact their respective medical aid societies for assistance,” said Ms Sanyanga.

Consumer Protection Commission of Zimbabwe chairperson, Dr Mthokozisi Nkosi said the move to make things difficult for consumers is tantamount to killing the goose that lays the eggs.

“It’s unfortunate when service providers randomly short-change consumers. It is important and works in the best interest of the service providers to warn consumers of any impending changes and there must be clear justifications for such actions.

“Sector regulators should be involved and approve those price adjustments. As the consumer watchdog, we will not allow such unilateral counter-productive behaviour to the already burdened consumer.

“You can’t kill the goose that lays eggs. You suffocate the consumer, they die today and your existence is equally threatened. We urge service providers to be responsible and consult widely before making such decisions,” said Dr Nkosi.

However, a local medical practitioner who declined to be named for fear of retribution said: “Medical aids societies set tariffs for medicines but I don’t know the criteria they use. However, pharmacies know the prices better, hence the shortfalls.

“Shortfalls come in when the tariff set by the medical aid company is lower than the market price. The difference is what the patient has to pay. Medical aid companies may set a price basing on the cheapest supplier on the market at that time.

“Unfortunately, prices for medicine keep changing while the medical aid companies do not update their tariffs regularly. In most cases they remain behind so that is where the problem lies.

“It is basically the same concept in private hospitals. Medical aid companies pay a certain amount for a certain service, but practitioners charge more than that amount. Again that extra cost goes to the patient, unfortunately,” he said. – Manica Post