Does your medical aid cover invasive medical procedures?

Before signing on the dotted line and choosing a suitable health insurance or medical aid plan, it would be to your advantage to have a look at the health cover that you’re entitled to. Your benefits are likely to be determined by the medical aid plan of your choice.

Having a clear understanding of all the surgical procedures and other benefits that you have access to could potentially save you a lot of trouble down the line. It’s especially important for those new to the medical aid market such as first-time purchasers and young working adults. If you fall into that category then we hope you’re paying special attention.


invasive medical procedures


As private healthcare becomes increasingly expensive globally, things are just not the way they used to be and benefits are becoming more and more of a scarce commodity. This, however, does not change the fact that having the necessary medical aid can literally be a life-saver, as was seen in our medical aid matters article not so long ago.


Medical aid schemes are likely to pay for the majority of your medical procedures but, when it comes to certain invasive, preventive and cosmetic procedures, there are some that they’re just not likely to cover you for. Unless there’s a substantiated medical reason that demonstrates that you require any form of surgery, you’re not likely to get the full cover. More and more people are opting to purchase ‘gap cover’ which covers those unforeseen or additional costs that sometimes arise with medical procedures – especially due to the fact that prices for procedures are not regulated, particularly in the private health sector.


We’ll be taking a closer look at some of the medical procedures that are least likely to be covered by medical aid.


  • Gastric bypasses/lapband (laparoscopic gastric banding)

Previously the cost for this type of procedure was not covered by medical aid schemes; however, as of late, a small group are including the payment of these procedures in their benefits. Whether they’ll cover the entire amount for the surgery or are only likely partly cover it will depend on the payment structure that they have in place.


  • Breast augmentation

As a form of cosmetic surgery, medical aid schemes are less likely to pay the expenses for any work that you need done to your breasts. However, there are some medical aid providers that will cover the cost for breast reductions, this has much to do with the fact that individuals with large breasts sometimes experience back pain – which can on occasion lead to extensive back problems.


  • Hearing Tests

Depending on your insurer the actual examination for potential hearing loss may be covered by your insurance but far fewer packages actually cover the cost of the hearing aid. Hearing aids are very expensive and, in a lot cases, the insurance industry may feel that, depending on the severity of the hearing loss, they may be more of a luxury than a medical necessity.


  • Elective dental surgery

Most forms of dental surgery are more related to improving your lifestyle than actually 'staying alive', which is basically the line insurance companies’ draw between paying out or not. From veneers to implants and dentures, you’ll rarely find comprehensive dental cover which doesn’t cost an arm and a leg anyway.


  • Preventative procedures

Prevention may be better than cure but for insurance companies, it could be bankrupting. This is again why their focus is on treatments for life-threatening or emergency medical conditions. Preventative treatments can consist of several things, for example, this could mean regular eye exams for diabetes sufferers. Some health insurance policies will cover several of these types of ‘procedures’ but it’s important that your doctor classifies your visit properly when you arrive.


Staying with the eye exam example, your doctor may log the examination as an ‘annual check-up’ rather than ‘diabetes prevention-related check-up’ – in which case you’d get the full or majority of the bill, even if your insurer normally covers preventive procedures.

In conclusion

In the end it’s all about what your needs are and where you feel you may be most exposed to risk or requirement. It’s hard to think of everything at the time but try and get your insurer to explain what’s covered under which circumstances – and always compare health insurance quotes

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