A whopping 76 percent of deliveries in SA are performed by C-section.
They are much more expensive than natural births – costing medical aids about R28 500 compared to about R16 500, with hospital costs making up about 70 percent of the total cost.
Peter Jordaan, acting principal officer of Fedhealth, says “consideration needs to be given to the additional costs associated with medically unnecessary C-sections”.
Although there is currently no differential between elective and non-elective C-sections, he says “this may not always be the case”.
Typically a medical scheme will cover hospital confinement at the scheme rate for three nights for a C-section delivery and two nights for a natural delivery.
In a statement, Jordaan offers couples advice on how to keep patient payments to a minimum:
* Register your pregnancy with your medical aid and obtain authorisation for the birth expenses. “Emergencies during a pregnancy will also require authorisation,” says Jordaan.
* Ensure that your chosen specialist – a gynaecologist or obstetrician – is covered by your medical aid scheme option. He says many women choose to go by word of mouth when selecting a specialist, but it isn’t always guaranteed that their scheme or option will cover their consultations. Make sure that any attending GP, paediatrician or anaesthetist is similarly covered.
* Make use of a network specialist or GP to ensure that your consultations are covered. “Many schemes provide unlimited visits on most of their plan options provided a network specialist or GP is consulted,” says Jordaan.
* Deliver your baby in a hospital or facility that is part of your scheme’s network. If not, you may have to pay in 40 percent of the total cost of your hospitalisation.
* Jordaan says that co-payments can also be reduced by making use of Designated Service Providers when it comes to purchasing medication.
* Scheme rules and clinical policies will also apply to routine procedures and blood work in pregnancy.
Jordaan says you should bear in mind that scheme rules change per option. “Make sure that you are on an appropriate option,” he concludes. - The Star