Can a lack of knowledge regarding Prescribed Minimum Benefits (PMBs) mean that you, instead of your medical scheme, end up paying for the treatment of conditions, diagnosis and care?

PMB's: Episode 2

		In this episode...
		Suzie meets Evelyn Evelyn's condition How Evelyn's medical aid helps pay for her condition.

Following Suzie's heart to heart with Nobolomko about  her hidden fears around medical aids and what they pay out for certain conditions, Suzie felt eager to tackle her fears, but she was also not about to jump into the deep end straight away. Instinct more than anything else, told her where her next visit would be, who the next person would be to talk to. Evelyn!

Suzie went to school with Evelyn and even though they weren't close in school, they had become much closer after a re-introduction by Evelyn's mom with whom Suzie had worked with a couple of years ago on a part time basis whilst studying.

It was during a lunch one afternoon that Barbara, Evelyn's mother, had revealed to Suzie that Evelyn had been diagnosed with Multiple Sclerosis. Being much younger at the time, Suzie didn't quite realise the severity of the diagnosis, but agreed to go and visit Evelyn to see what she was getting up to with her life. "Be careful though Suzie!" Barbara had warned. "She's become feisty; total opposite of the girl you remember from school." Suzie remembers thinking out loud: "Whaaaaatt? Evelyn? No way!" Barbara had laughed and simply reiterated her warning.

Evelyn recalls now that Suzie had arrived at possibly the worst time that she could have to discover the full effects of Multiple Sclerosis on its victim. When Suzie arrived at Evelyn's house, Suzie found Evelyn dishing out orders to a few others at the house like a sergeant to her troops. Suzie recalls this to be her first shock among many for the day. Walking in to the lounge Suzie got her first glimpse of Evelyn and started crying without restraint. Evelyn's entire right side of her body was lame, she couldn't move. Evelyn, not wanting anyone to pity her, wagged that commanding finger and said, "You get two minutes to cry Suzie, then your time's up. After that you've got to toughen up!"

It took Suzie a while to calm down, but when all the fussing was over she and Evelyn got to talking about the last few years, it became clear to Suzie that Evelyn had changed dramatically. Strangely though, Suzie remembered feeling deeply inspired by Evelyn's empowering story over Multiple Sclerosis. And so, over the years they had become close friends.

Suzie had burning questions that needed answering and on her next visit to Evelyn she plucked up the courage and asked the question "Evelyn, how do you cope with all the costs for treatment and medication? Does your mom help?" With half a smile, Evelyn simply shrugged and said that her medical aid paid for all of it. "But aren't you on a simple hospital plan?" Suzie enquired. "Yes sure, but remember that many chronic diseases such as mine are covered under Prescribed Minimum Benefits, which means it's something that any medical aid, by law, has to cover. There are actually around 26 chronic diseases listed in the CDL (or the Chronic Disease List) covered in this way so it insures that people like me get the care I need." Without noticing, Suzie breathed a sigh of relief as she digested what Evelyn was saying.

Evelyn elaborated a little saying that when the same dreadful thoughts about the cost of treatment occurred to her, she approached her medical aid broker who thoroughly detailed these 'Prescribed Minimum Benefits' and explained that they actually covered many different situations such as emergencies, HIV, 26 chronic diseases and a multitude of other conditions. "There are some rules that the medical aid can impose, like who you get your medication from, which they refer to as DSPs or 'Designated Service Providers' and chronic medication benefit programmes that you should be part of, but it all works out in the end. The best thing to do is to read up on the law and then read up on how your particular medical aid applies that law in practice. And don't be afraid to ask questions and demand thorough answers Suzie, it's their job to give you those answers!"

After the visit, Suzie felt lighter and more assured and knew then that 'Lomko had been right. If Evelyn could face these questions then she could too and this 'Prescribed Minimum Benefits' thing was beginning to sound like something that would ease many of her concerns. Suzie was ready to face the tougher questions.