The law requires your medical aid scheme to provide you with Prescribed Minimum Benefits medical cover, but you also have specific responsibilities when using this cover and the duty to know what it is and how to use it.
Diagnosis, where a doctor looks only at the symptoms and not at any other factors, such as how an injury was sustained, or the condition was contracted. Once the doctor has made the diagnosis, he can decide on the appropriate treatment and care and where the patient should receive the recommended treatment .
The guidelines specify that in an emergency, where you cannot go to a DSP, you are treated and stabilised in the closest hospital, but your medical aid scheme can decide to move you to a network hospital once you can be moved. Learn as much as possible about your condition and available medications and treatments. If a generic drug is available, conduct your research to determine whether it differs from branded medicine, or ask your doctor.
Ensure that your doctor submits an accurate account to the medical scheme with the correct ICD-10 code to streamline the claims process.
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