NHS versus Private Medical Aid

For 39 years I was only aware of the NHS. Yes, there was private care available at a cost in the UK, but it usually came with a benefit package or the rich used it. Despite needing hospital care in the UK the private scheme was only ever used the once by hubby as in the past treatment needed hadn't fallen into the right category. I've had a few stays in hospital with viral meningitis and pneumonia and other things and all of them were 999 calls/emergencies so never really stopped to think about using the private care and apart from service in the NHS being slow, there's never really been an issue. On moving to South Africa less than 2 years ago, our only option is private medical care, so we've been told and although its part of a benefit package hubby still has to contribute 50% of the monthly cost and it's a taxable benefit. There was the cricket ball in the throat incident, pay cash up front, claim back from med aid, bills sent directly to us to pay, but not receiving them so issued with court orders to pay as the med aid wasn't linked to the emergency hospital son was taken to. Emergency surgery after the heelies accident, now apart from the cast being too tight, that all worked out well, from A&E to surgery, to ward to discharge, less than 24hours. There's been a CT scan after I was dehydrated, numerous dental treatments and doctor’s appointments. We've certainly had our monies worth from it but what has been the real cost? I personally think Private medical care is a waste of money, time and effort and so far it has caused me more stress than any of the treatments, surgery and emergencies that have happened so far. When admitted to hospital you have to set up an account, so your child is separated from you while you complete paperwork, provide copies of ID and med aid, know your hubbies works number off the top of your head as in any emergency you're never prepared. Did you know you can request which hospital you want the ambulance to take you to? Then the hospital will ask you after they've carried out initial treatment what scans/tests etc do you want? You're the bloody experts, you tell me. Do you want to be admitted? I don't know how much does that cost? Then of course you say yes to the tests and no you'll take child home if the hospital say it's ok to discover that now you have to phone your med aid and ask permission for the tests, you discover the hospital you are at doesn't meet with the med aids agreed prices and you have to then hand your bank card over for them to take the necessary payments, because they don't tell you this until afterwards or unless you ask, keep the receipt and spend next 6 months arguing with the med aid for a full refund...It was an emergency. Oh and don't forget the payment gap you'll end up in, the what? Exactly. You go to the Doctors or are half way through dental treatment and your funds run out. Yes seriously and the first you know about it is when a bill arrives or you get a phone call demanding payment. It's even more annoying when you explain to the med aid that you don't know how any of this works, as you are only used to free treatment as you're from the UK, you finally get informed that there's a drop in centre nearby where you can ask to speak with someone to explain all of this to you. So you visit every time you ne something or you get a bill and they are very good at reading off the computer, emailing you cut and paste and putting you on the phone to someone above them who is more qualified to answer your question, when all they then do is read off a piece of paper. This week I was admitted to hospital for day surgery. It was 6 weeks from referral by doctor to appointment and the actual procedure. Which compared to the NHS is bloody brilliant, but the stress of organising it was immense. R500 payable on initial consultation, claimed back from med aid. Completion of consent forms for surgery and all med aid details including car registration numbers for both myself and hubby (no parking permit was issued) details of next of kin in South Africa and as we are immigrants, contact for family members in the UK. Then there was approval from the med aid, the hospital contacted me to say I'd need to pay R3500 towards the treatment, so a visit to the med aid drop in centre, a phone call to discover that they won't pay for two treatments in the same year. But I wasn't having two treatments in the same year, but according to med aid level 1 injection were the same as level 2 injections. The physio and anaesthetist come to see me, told to refrain from driving for 48hrs and my neck may be sore for a week. At the consultation I was informed I'd be sedated and a needle would be inserted into my nerves on both sides of my neck from C1-7 and an electrical pulse would stimulate the nerves. I was put under and the procedure lasted 90 mins, I came round and my blood pressure was 57/40 something, I was dehydrated and it took 2 hours for the drip to pass through and I was discharged at 5pm. On arriving home I stepped out the car and collapsed on the drive, I've been in bed ever since with this (sat pm) being the first time I've been able to sit up for more than a few minutes without incredible neck pain. On calling the hospital on Friday I was told I had to have complete bed rest till Tuesday, take the meds as prescribed, despite instruction on box saying 'when needed' and to drink caffeine, coke and eat chocolates to keep my blood sugar levels up, my feet elevated and not to attempt to stand unaided and not to be left alone. Now hubby wouldn't have gone to Cape Town Thursday till Saturday had we been given that information at the hospital. And thanks to med aid company I now have to go through the whole procedure level 2 again in January when the New Year starts which will mean with the costs that we will be in the payment gap sooner than we want. In the meantime I'm trying to find a perodontist that works within the med aid figures and despite requesting that the med aid company find me one, I'm still waiting for the surgery I need to resolve and slow down the bone degeneration I have and prevent my teeth from falling out. I'd rather have the NHS any day, thank you very much. I may have to wait longer but from previous experience, there is less stress prior to the event and after. My father had a heart attack in June, the only option he had was the NHS, their care during and after was fantastic and the help he receives now is amazing. No wonder I'm suffering from depression, most of it caused by my lack of knowledge and the medical aids lack of understanding in response to 'I don't know how this all works, please help'

It has to get worse before it can get better

I should have waited till the end of the week before writing about the help I'm getting to treat my depression, because I just can't believe that the day just got worse and landed me up in the doctors surgery on a drip treating the worse migraine ever.

If you want/need to catch up then you can click here to see why I went to the Doctors for help this week.

OK I'M NOT DYING...In fact I do not even have anything officially wrong with me medically, but I'm ill and it's been getting worse.

You see I have a few 'little' things wrong with me. Which on their own are painful and can be an inconvience, but when you put them all together at the same time and chuck in the whole 'I'm struggling to be an expat, adjust to my new life, moved house (again) Dad had a heart attack, youngest has dyslexia and dysgraphia, giving up smoking and didn't get a role at the London Olympics that I'd set my heart on' you'll see why I'm having a tough time and why I've asked for help to treat depression and take Prozac.

So what is wrong with me?

I need oral surgery to stop my teeth falling out and it's linked with diabeties and the perodontist hasn't seen a case this bad, ever, in anyone under 65. My bones are degenerating.

I have chilblains due to poor circulation aka Smoking

I've suffered with migraines since I was a small child

I had viral menegitis in 2000 which rears it's ugly head from time to time

I've had pneumonia on more than one occassion, in the last 5 years

I was a victim of assualt, 15 years ago, and suffered nerve damage to my neck for which I require regular pain killers and hospital treatment

There is a history of high cholestorol and diabeties in the family of which I now have elevated levels and I will be diabetic one day

...and all raising it's ugly head at the same time.

So I left the doctors on Monday with medication for pain, chilblains and Prozac. I had appointments lined up for blood tests, clinical psychologist, pain clinic, diabetic clinic, I forget what else and i go home to a very confused and worried hubby, but I actually felt a bit better, until tuesday morning after the blood tests when a pain in my head appeared from nowhere. It felt like someone was hitting me over and over with a hammer and I couldn't do a thing to stop it, meds, resting, darkened room and after what seemed like forever, hubby got home and took me to the doctors where they hooked me up onto a drip for an hour to administer medication. I could hardly move my head on wednesday and today thursday my neck is so stiff I have to move my entire body to look round. My head feels heavy, yet it's still thumping and it feels like someone is pushing on the back of my neck all the time.

But I have appointments, I'm getting something done about it all, but let me tell you it's not easy, I'm feeling more stress now than I did on Monday when I turned up at the doctors asking for help.

Our medical scheme, Discovery, have a payment gap thingy that I have to submit bills to, to reduce the gap then the med aid kicks back in. It's probably a bit more technical than that but.... and I have to request permission in advance of certain treatments or they'll not pay out or only pay a small amount if the health care provider doesn't charge the Discovery rates. So basically I don't know if all my treatment will be covered until I contact the health care provider and request codes to see if a) Discovery will pay for it and b) if Discovery will pay the full rate.

I now have to find a perodontist who fits the above criteria as the one I was recommended to see by a Dentist who does meet the criteria, will charge me R30,000 and Discovery will only pay back around R10,000.

I've lost count of the number of times I've emailed, telephoned and visited in person at Discovery to say 'I haven't moved from one scheme to another, I've moved from the UK and no scheme, it was free'. I'm also fed up of saying 'I don't know what to do or how to do it, therefore I do not know what questions I need to ask and it keeps costing me money because I didn't know if I said a, b or c, it would've been covered'

So back now to the depression. I'm so angry with hubbies company that the Medical wasn't set up when we arrived, despite requesting it over and over, telling both the company and Discovery 'we don't know how it works, please help us' and being greated with 'here are all the lovely bonus things you can get from us' and 'an advisor will be in the office on wednesday' who then failed to turn up on two occassions.

I can still see the light at the end of the tunnel. My family and friends* are being amazing. It will get better, it'll be different. I can't let go of the crap of the move and lack of support from hubbies company till they say sorry, despite them asking what they can do and us saying 'try saying sorry' There are still a few contractual issues to sort out and they won't rock the boat with the agency that handled and cocked up our house move as they are processing our visa renewals at the moment.

So I guess I need a bit more time before I will start to see the benefits of asking for help, the appointments and waiting for the prozac to kick in...in the meantime I'll leave you with my next trick which is...

things can't get anyworse or more stressful so I thought today would be the best day to smoke my last cigarette.

*twitter

Another hospital trip...you must be joking

We'd been in South Africa 8 days when we got a call to say Dan was on route to hospital after being hit in the neck with a cricket ball. You can read my version of it all here http://www.chickenruby.com/2011/02/this-is-how-day-started-trip-to.html

This is Dans version http://www.chickenruby.com/2011/02/guest-post-by-blakey108-my-16yo-son.html

the there was Alex's broken arm http://www.chickenruby.com/2011/08/so-youve-broken-your-armwhat-next.html

and last night it was the 'HEELY INCIDENT'

hanging on to a golf cart, down hill, stone wedged itself under the wheels, Alex goes arse over tit and we end up in A&E for a couple of hours, xxx amount of Rand lighter and another battle with Discovery to get our money back.

Bit of research coming up you can help with me if you wouldn't mind...

Does anyone know of a hospital in Centurion that covers the full amount and doesn't require us to pay up front?

By the way Ales is fine, xrays, tetnus, wouds cleaned and a smashing black eye to boot and accompanied by a Doctors note he's gone on his school trip to Durban.