Be network-savvy to avoid unexpected healthcare costs

Having a health plan with network restrictions impacts your day-to-day benefits and the medical aid cover you have at certain healthcare providers. Some medical schemes have arrangements in place that allow a lower contribution for members within a network. This is great for members, since the scheme can offer full cover at these networks.

Not only would this keep your healthcare costs down, but usually, the scheme will also pay healthcare professionals within their network directly, reducing your administrative load. Here are three ways you can save by being network-savvy: 

1. At your GP

Some doctors charge more than the tariff specified by your medical scheme. This is something they have a right to do, but it means that if your health plan only covers you for the specified tariff, you may be liable for a co-payment.

Patients are often embarrassed to discuss money with their healthcare provider, but when you make an appointment, you're entitled to ask what rates your doctor charges and whether or not you'll be liable for any co-payments. Doing so means you can make informed decisions about how you're spending your funds. If you're set on that specific provider and are happy to pay more, at least you'll know up'front exactly how much.

"However," suggests Deon Kotzé, Head of Discovery Health, Vitality and Discovery Card Technical Marketing, "if affordability is a concern, rather shop around for a provider who charges at NHRPL (National Health Reference Price List) rates. Discovery Health Medical Scheme has an extensive GP network and, for lower income earners, the KeyCare GP network."

Premier Plus GPs

A Premier Plus GP is a network GP who has contracted with Discovery Health Medical Scheme to provide high quality healthcare for conditions.

If you are registered on the DiabetesCare or HIVCare programmes, and you are on a Priority, Saver, Smart, Core or KeyCare plan, you have to use a Premier Plus GP to manage your condition to avoid a 20% co-payment.

2. At specialists

Discovery Health Medical Scheme also has direct payment arrangements in place with nearly 90% of SA's specialists on most of its plans. If you see one of these specialists, you won't be liable for any co-payments. But if you choose to see another specialist, you may need to pay up-front or pay a portion of the costs yourself - depending on your plan.

Check your policy or contact your scheme's call centre to find out what your options are. Don't be shy to discuss and agree on rates with your specialist.

3. At pharmacies

Some medical schemes have pharmacy networks that offer no co-payment on medicines that are on the scheme's medicine list. For example, Discovery Health Medical Scheme has over 2 500 pharmacies in their network for members to choose from.

It's worth finding out whether your medical scheme offers you this service so you can save as much on your medicine spend as possible. Also, ask your pharmacist about generic alternatives to branded medicines that cost less but are similar, composition-wise.

As Kotzé says, "Learning how to take advantage of networks is smart because it can save you hundreds of rands in healthcare expenses a year."