When my wife dreams, her dreams are blurry. Her mind’s eye is based on her real eyes, which are weak. We tried to have Lasik surgery done to correct this. Here’s what happened…
We don’t have oodles of cash lying around. What we do have though, is health. Since the entire family quaff a Herbalife shake every day, we’re never ill. At least not ill enough to actually seek medical attention. Being healthy all the time means never using our Medical Savings Account that is linked our Discovery medical aid plan. So we ended up with some R20000 sitting around in the fund. This lead me to investigate whether Discovery would pay for lasik, if we elected to have it. Since it’s considered a cosmetic procedure, not all medical aid schemes will pay for it.
One phone call confirmed that Discovery will pay for the surgery. Entirely from our MSA, but they’ll pay. Great! Right? Well, here’s where it gets tricky…
I called a local ophthalmologist who performs the surgery and ask if they deal with Discovery. Their response, “yes, but you have to pay up front and claim back.”
This isn’t the end of the world, because we can make that happen.
We arrive at the doctors rooms for the initial consultation and tests. The nerves are buzzing in anticipation of the scary outcome. Then finally, “Yes, you are eligible for surgery. You’re going to see without glasses.” What a moment! Nadine is ecstatic!
Time to pay. No problem, we came prepared. To be sure, I ask again, “Do you contract to Discovery medical aid?”
“It’s cheaper to pay up front and claim it back” she says. Sure, we knew this coming in. Here’s your R1500. I take a receipt, but the lady says that she’ll email a statement to me that includes the payment, so the medical aid can see that it’s paid and reimburse me. We thank her for her thoughtfulness and leave.
The next day I receive the statement, and duly claim from the medical aid.
R1200 refunded. Wait. What?
I query this with Discovery and they tell me that the doctor has charged more than the Discovery Health Rate.
Now I’m confused. The doctor told me that it’s cheaper to pay up front and claim back from Discovery, but now Discovery has refunded me LESS than what I paid.
Something doesn’t fit. I’m out-of-pocket by R300.
Now R300 on a R1500 bill is a manageable knock, but what if the same thing happens on the R15000 surgery bill?
Obviously I was a little nervous, so I postponed the operation until the financial aspect had been sorted out.
To get to the bottom of what just happened, I pop a mail off to the doctor. Here’s the reply, “oh, if I’d know that you were going to claim from the medical aid, I would have sent you the medical aid statement. The one I sent you was the private rate statement.”
The original statement they sent me was this one:
And here’s the “medical aid” statement:
Can you spot the difference?
Spoiler: The actual consultation is R300 more, but the individual tests are all less.
I don’t work in the medical industry, so I have no idea why they would have a “Private rate” statement and a “Medical Aid rate” statement prepared, when the total ends up being the same anyway? Both statements total up to R1500. Surely people who are paying privately aren’t really bothered by the break down? To this particular layman, the “medical aid rate” statement actually appears better. The “Private rate” consultation fee is R700-odd and that seems like a rip off, compared to the R400-odd. Maybe it makes sense to someone who actually deals with this stuff every day, but to me, it just looks underhanded. It looks like someone is trying to scam someone else.
OK, so we get this all sorted out. I now understand that it was all a miscommunication between different people within the doctors rooms. The person who took my money didn’t mention that I planned to claim from the medical aid. So the person issuing the statement didn’t know to give me that particular statement. Got it.
This means that if I specifically ask for a medical aid rate statement, I’ll still be reimbursed the full amount that I pay out for the surgery.
Let’s move on.
I emailed them to reschedule the surgery, and got this reply:
“Unfortunately those were the only lists Dr X could accommodate before his forthcoming trip to further specialise.
I cannot complete the forms as 2015 rates will only be available in January 2015.
…there are no bookings for Lasik for 2015 as yet.”
After I stopped crying I did suggest that the correct time to let me know that the doctor is performing no more surgeries this year would have been at the time that I postponed. Their response was that I’d postponed with the theatre and not the doctor, so it’s not their problem. My calls are recorded, so I could dispute that. By this point though, I’m in more of a “fnck it! let’s go elsewhere” mood. Especially since there’s already some perceived underhandedness happening here.
So I contact a new doctor. Who coincidentally, it seems, has already had a discussion about me with the last doctor. <– why? Has the underhandedness now been transferred?
There was a very long conversation about the medical aid versus private thing again. Mainly because we need to do the initial consultation over again with the new doctor. Apparently, even though doctors can share account information with each other, they cannot use the results of exactly the same tests. So the new doctor has to re-do all the tests that we have already wasted R1500 doing.
OK, fine. New doctor, new tests. Let’s move on.
Only now I cannot just walk in and pay the R1500 initial consultation. This doctor knows that I am with Discovery so they HAVE to charge the discovery rates. They may not charge me as a private patient, even if I choose to skip my medical aid altogether. <– really? Can this be real? dubious start…
So how much will it cost? Well, your guess is as good as mine.
I had a long conversation with the rooms about the cost of the initial consultation, but they were reluctant to give me Rand values.
Eventually, after much coercion on my part, I start listing the procedure codes. I know these because the previous doctor has already billed me for them.
Here they are:
0190 – R472.30
3003 – R106.90
3006 – R106.90
3009 – R178.40
3014 – R106.90
3036 – R549.80 x2 = R1099.80
3020 – R702.50 x2 = R1405.00
Yes folks, that’s a total of R3476.20!
Tyrone: “OK, so the very maximum that I’ll have to pay is R3500?”
Rooms: “Well, no…the doctor could order other tests.”
Tyrone: “ok, what are those codes and prices of those?”
Rooms: “I can’t tell you.”
Tyrone: *cries* <– again.
So the total could be R3500, it could be less or it could be more. We’ll never know.
But that’s just the initial consultation. After that I still have to actually have the surgery.
Here are snapshots of the actual quotes that I received for the surgery:
That’s R21136.40 for anyone who doesn’t feel like working it out.
…and there’s the last R9807.49 for the use of the theatre for 30 minutes.
So, drum roll please…
Initial consultation – R3500.00
Doctor’s surgery – R21136.40
Theatre charges – R9807.49
Grand total – R34443.89
That is a LOT of money! Especially considering that if you just pay for it out of your pocket the total comes to R16200. That amount I can cover from my MSA.
I should probably let Discovery know that they’re being completely ripped off here…
…but this exercise got me thinking.
We’re currently hosting a friend from Hyderabad in India.
How much would he have to pay if he chooses to have lasik surgery?
Well, according to http://www.whatclinic.com/laser-eye/india/hyderabad/lasik, I could use this clinic:
Between R3571.00 and R6250.00!
Ok, ok, I know, it’s 8000km away. So we’d have to fly there.
I used http://www.expedia.co.in/ to look for flights.
If we fly South African Airways, here’s the trip summary:
Rs. 99892.00 seems like a huge amount, but at today’s exchange rate, it’s really only R17799.81.
Remember that I was only thinking about this because we’re currently hosting our friend Kartik. So he’ll reciprocate in Hyderabad. But just for the sake of completeness, I looked into accommodation for a week too.
According to http://www.booking.com/ we can stay at the three star Hotel Mandakini Jaya International for 6 nights for R1695.00
But hey! We’re on holiday right? Why not do it properly and stay at The Palazzo or the Radisson
Yes, I think it’ll be the five-star Radisson for 6 nights for R4009.
Let’s take a moment to take stock of what we’ve just discovered.
LASIK Surgery – R6250.00 <– the maximum.
Flights to India for 2 – R17800.00
5 star Hotel for 6 nights – R4009.00 <– not really needed, but why not?
Grand Total – R28059.00
So there you have it.
If you’re like most people and don’t have oodles of cash lying around. You have to use your medical aid to pay for LASIK surgery. Remembering that they pay it from your savings account which is essentially your own money.
It is physically cheaper by R6300 to fly to India, with a partner. Stay in the 5 star Radisson Hotel and have your surgery done there.
We won’t be staying in the Radisson, but we shall be having Nadine’s eyes done in Hyderabad in India.
The only sad thing is that we’ll only get around to doing it next year, because we have already committed ourselves to Thailand this year.
Just some food for thought. Use it as you please.