There are probably 50 reasons why you should take out GAP cover, but here are three of the most important ones:

• GAP cover will take care of the shortfall of specialists’ fees with an in-hospital procedure. Specialists always charge more than medical aid rates so there is always a shortfall. If you haven’t got GAP cover, you are liable for the payment of the shortfall – and it could be a very hefty sum.
• Some hospitals and comprehensive medical plans offer cover at 100%, 150% or 200% of medical aid rates for hospitalisation costs only. The actual costs, much to your surprise, could well be more than 500% of medical aid rates. GAP cover will make up the difference between what is paid by your medical aid and the actual cost.
• There are certain procedures that are now performed in doctor’s rooms, or day clinics, and these will be covered by GAP cover. However, the procedures and their authorization vary between companies. It is always best to check what procedures can be performed.

The last thing on your mind when you’re recovering from an operation should be financial problems. Unfortunately, this is very often the case, and this will greatly affect your recovery. Many people find that they have to take out loans from their banks. That’s if they can get the loans. Otherwise, they must make payment plans with the specialist involved.

Patients complain bitterly about the debt collection services’ attitude regarding money that is owed to specialists. They claim they are harassed throughout the day (and night sometimes) until the money is finally paid. “As if the surgeon really needs the money. For his third yacht?” complained a blogger.

Prepped for surgery – but sign this contract

The point is made, but if money is owed this is normally the practice that is followed. With any business procedure, if money is owed to someone, it needs to be repaid. But there’s another very valid complaint that bloggers make.

Very often, the patient has been prepped for surgery and is about to be wheeled into theatre when the anaethetist will run up and ask what medical aid the patient is on and then is asked to sign something which declares the patient must pay a shortfall in funds.

Very often the patient has been given a pre-op sedative, is traumatised and was totally unaware that any kind of payment would have to be made. This kind of practice is unacceptable and from the complaints that have been noted online, it is a common occurrence.

When the patient is notified that hospitalisation is necessary, very few ask about shortfalls and co-payments, and in most instances, they are not informed by their medical aids about these obligations.

Another huge reason for taking out GAP cover

Medical aids have been very remiss in the lack of education that is passed onto members. This is an age-old complaint which shows no sign of abating.

However, be this as it may, this is another huge reason for taking out GAP cover. If you’re sensible enough to have done that, there will be no frantic must-sign-contracts as you’re being taken into theatre. And no debt collectors banging on your door. You can rest assured that you are covered for most anything.