Medical aid to die for

You know all those stories about near-death experiences? The loooong passage, the beckoning figure silhouetted against a bright light at the end of the tunnel … Well, that wasn’t exactly my experience, but it came close, even though I was nowhere near dying — I simply had a broken wrist after tossing my KLR into the bushes.

The hospital corridor they wheeled me down seemed endless, and the bright light in the theatre gave the welcoming figure standing in the doorway an eerie halo. Then he ruined it by speaking. “Hi,” he said jovially. “I’m your anaesthetist. Did they tell you that we’re contracted out of medical aid?” When I suggested it was a little late to start negotiating, he agreed. Then he stuck a needle in my arm and melted away into the darkness that descended upon me, ending the debate in seconds.

I woke up about two hours later with a R4 900 stainless-steel plate measuring about 60mm by 18mm holding my left radius together, with the help of five little self-tapping screws that cost me R390 each. My medical friend was nowhere to be seen, but he’d left a bill for R1 500 — double the medical-aid rate — stapled to my forehead. Not really, but it arrived at my house before I did, so they might as well have saved the postage. What really peeved me was the R185,30 listed for “Pre-anaesthetic assessment”. All the bastard assessed before punching my lights out with his little needle was the thickness of my wallet. I don’t know what he did after that, but anything that happened was not pre-anaesthesia.

Imagine what life would be like if everybody ran their businesses like the medical people do. You fall off your bike and take it to your dealer for repair after you see the forks are bent and the clutch lever broken. “Oh dear,” the mechanic says. “Looks to me like you’ve broken the clutch lever and bent the forks,” he adds, handing you a letter to take to his mate, the photographer. “We’d better get it checked out.”

Off you trot to the photographic studio, where a bored-looking poppie in a gleaming white frokkie props your bike up in front of a camera and clicks the shutter. “Hmmm,” says the photographer when she hands him the pictures a few minutes later. On your way back to the bike shop you read the report he spent five minutes typing. It says, in a long-winded way, that your bike appears to have suffered a bent fork and a broken clutch lever. When you get home you find a bill for R1 700 from the photographer waiting in the post box, alongside a final demand for payment.

You pick up your now-repaired bike a few days later, and your mechanic hands you the bill for the job. The tie-down he used to hold it on the bench cost a mystifying R1 283, and apparently can’t be used again, and the soap they used to clean the bike afterwards costs an astonishing R800 per litre. The forks are still bent, but less so, and the new R5 000 clutch lever doesn’t fit properly. The labour for the job cost R7 000 per hour, plus the R2 000 per day they’ve charged to keep your bike under observation in the storeroom next to the workshop.

There’s also a further bill for R900 from the photographer. “We sent your bike back to him after we’d fixed it, and it appears the forks are still slightly bent. The lever doesn’t really fit too well either,” says the mechanic. “If you like we can have another go at it, but it’ll be more expensive the next time round because we have to undo what we did before, and there’s no guarantee it’ll be any better.”

Then he tells you that he charges treble the labour rate your insurance is willing to pay, but if you pay the entire bill immediately, he’ll give you a discount and you can claim some of the money back from your insurer.

My little tumble generated a bill of about R15 000 for repairs to the bike, and somewhere in the vicinity of R35 000 for the damage to me. My bike insurer gave me absolutely no grief at all, paying everything except the R2 000 excess stipulated in the policy document. The bike’s now as good as new, but my arm didn’t work out so well, and the quack says things don’t look good — my wrist has lost most of its movement and I’ll probably need another operation to fuse the joint and stop the pain. The surgeon’s bill so far has reached R10 000, of which medical aid refunded R2 900, and the anaesthetist charged R1 500 — treble the amount Discovery Health is willing to cough up.

What I’ve learnt from this little exercise is that it’s worth reading the fine print on your medical-aid contract. When it says that it will cover 100% of your bills if you’re hospitalised, it means it will pay whatever it has decided the job is worth, not the amount the various doctors and anaesthetists think is reasonable. My body I got brand-new for free, but repair costs can be horrendous, and, of course there are no guarantees that anything’s going to work after the medical muggers have had their way with it. At least with bike insurance you know exactly how much you’re in for, and that things will be right when the job’s been done.