Covid and your medical aid
The family of the late radio host Dr Sindi van Zyl have struggled to pay her medical bills. Are you properly covered if you catch the virus and land up in hospital?
HE COULDN’T believe it was happening – not to his beautiful, vibrant wife. As a doctor, Sindi van Zyl had always been strong and fearless and totally committed to saving the lives of others but now here she lay in hospital, so fragile and vulnerable, her own life hanging in the balance.
After catching Covid-19, Sindi (45), developed complications which resulted in her spending almost eight weeks in ICU. When she was put on a ventilator, all her husband Marinus van Zyl could do was hope that she’d pull through.
But, sadly, it was not to be. South Africans were stunned when news broke that the much-loved doctor and radio host had died.
Marinus is devastated, but now instead of being able to focus solely on grieving for his spouse and being there for their kids, Nandi (11) and Manie (8), he has had another worry on his plate: to come up with ways to pay her exorbitant medical bills.
When Sindi fell ill, her family wanted her to have the best possible care. Even though she didn’t have medical aid she was admitted to Netcare Olivedale Hospital in Johannesburg, a private facility.
They hoped she’d make a speedy recovery but as the days stretched into weeks and Sindi required life support, the bills piled up, rapidly hitting the R2 million-mark.
How is it possible that a doctor could land up in this situation? Her misfortune was that she fell ill when she was between medical aids.
Sindi had decided to switch schemes
and quit her medical aid before signing up for alternative cover.
“She was still trying to decide which one was best, and she’s the doctor in the home so we all left that to her,” Marinus, who works in IT, told the Sunday Times.
Eventually he reached out to the public with a plea for donations.
In a statement on crowdfunding website Quicket, Marinus revealed that the cost of keeping his wife on a ventilator was around R15 000 a week – and that’s over and above all the other ICU costs.
“We will use any funds raised to pay the medical bills,” he added.
As a result of the show she used to host on Kaya FM called Sidebar with Sindi, the Zimbabwean-born doctor was wellknown to South Africans and was affectionately known as “the duchess of healing”.
Within days of Marinus launching his appeal, donations flooded in.
He recently revealed that more than R1,7m was donated and announced that once all her medical bills are paid, anything left over will be used to launch a foundation in Sindi’s name to support the causes that were close to her heart.
While the outpouring of generosity has taken some of the weight off his shoulders, Sindi’s predicament has left many people wondering about Covid and medical cover. Even if you belong to a scheme how much will actually be paid out if you land up in ICU – and what happens if you develop what’s known as “long Covid” and require weeks or months of out-of-hospital treatment?
COVID AND MEDICAL AIDS: WHAT YOU NEED TO KNOW
Had Sindi been on a medical scheme, there would’ve been no need to raise money for her treatment.
This is because Covid-19 is one of the illnesses or conditions which have to be covered by medical aids in terms of the prescribed minimum benefits (PMBs) that funds have to provide for their members.
So just as they are compelled to cover conditions such as asthma and diabetes, they’re also obliged to foot the costs related to the diagnosis, treatment and care of Covid as well.
However the amount of cover you’re entitled to will depend on your provider and the plan you’re on.
Dr Timi Modupe, a senior clinical manager at the Council for Medical Schemes, says in addition to Covid itself, the complications it causes such as pneumonia, respiratory failure, renal failure and complete or partial lung collapse are also included in the list of PMBs and should be covered.
“All medical schemes are required by law to pay for the diagnosis, treatment and care costs for these conditions in full irrespective of plan type or option,” he says.
Medical schemes may not fund treatment from a member’s medical savings as this would be a violation of the PMB regulations, Modupe adds
QUESTIONS TO ASK YOUR MEDICAL AID PROVIDER
Chairperson of the South African Medical
Association Dr Angelique Coetzee says as soon you test positive for Covid-19, you need to check with your medical aid scheme what you’re covered for and for how long.
She says for hospital admissions, schemes are required to pay full costs of all treatments related to the virus since it’s a PMB, but it becomes trickier when you’re treated out of hospital.
They tend not to cover PMBs out of hospital in full, she warns, so you’d need to check with your medical scheme.
If you’re switching medical aids it’s important to check on Covid cover with your new provider. Discovery, for instance, has announced that the usual three-month exclusion period doesn’t apply for Covid and that claims will be covered straight away.
WHAT ABOUT GAP COVER?
Gap cover shouldn’t be too much of a concern because as Covid is a PMB, medical schemes should pay in full if you’re hospitalised, Coetzee says.
However, if you have long Covid and your medical scheme only partially covers your doctors’ bills and tests that result from complications relating to the virus, gap cover could prove useful.
Ask your gap cover provider how much you’ll be entitled to claim back.
EVEN IF YOU BELONG TO A SCHEME HOW MUCH WILL ACTUALLY BE PAID OUT IF YOU LAND UP IN ICU?