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 3

		In this episode...
		Suzie’s thoughts about her dad’s passing Suzie and Sarah’s dinner date How Sarah’s Broker coached her through all her medical bills

With all the information that Evelyn so freely offered regarding her Multiple Sclerosis, Suzie felt inspired to continue with her quest. Suzie was ready to face her own family’s medical history.

Two years ago Sarah, Suzie’s mom, called her to tell her that her father had been diagnosed with lung cancer. Sarah recalls the cold feeling like it was yesterday remembering how her first verbal reaction was “Have you gone for a second opinion? This can’t be! Dad isn’t a smoker, he’s fit and strong!” Sarah assured Suzie that they had been to see two specialists who confirmed the diagnosis. In that moment it was as though Suzie’s world had just crumbled into tiny insignificant pieces. She couldn’t speak, but held on to the phone, tears streaming down her face as the next few moments passed by in slow motion and utter silence. Her dad was her hero and heroes don’t get cancer! Chris, Suzie’s dad, passed away eight months later. The cancer was aggressive and had been discovered too late for the treatments to have been affective. Reliving that time was not going to be easy, but Suzie new it had to be done.

Every Friday night Suzie and her mom Sarah have a dinner date, which they continued after her father passed away as part of a promise to him to keep the family together after he was gone. When she arrived this Friday, Sarah already knew Suzie had some questions to ask concerning the part the medical aid played in the ordeal and how much it affected her mom’s financial situation. They sat down engulfed in the beautiful aroma of roast beef and steamed vegetables and before Suzie could even dish up her first helping Sarah plopped a pile of papers on the table. “I know we always said not to do this kind of thing at the table Suzie” said Sarah “, but I know what’s on your mind and it pains me to see you filled with fear, not allowing yourself to live a full and happy life!” Dumbstruck Suzie pointed to the pile of papers and asked “So what are those?” Sarah looked down and smiled. “Quite honestly I don’t really know Suzie. It’s a mixture of hospital bills, documents, notices and so on and when they first started arriving I called my broker up in a panic.”

Sarah paused for a moment, which made Suzie shift in her seat feeling like she was about to hear how terrible the ordeal was and that half of her parents life savings had disappeared along with her father’s death. Sarah smiled calmly and said “Suzie, the broker told me to simply put all the documents together and mail them to the medical aid, the rest would be taken care of over time.” Of course this, at the time, did not sooth Sarah’s mom one bit. “But where am I going to get the money to pay for all of this?” Sarah asked her broker. “Sarah,” the broker prompted, “don’t think for a moment I would take this situation lightly, but please believe me and mail all the documents to your medical aid. With the laws in South Africa regarding Prescribed Minimum Benefits your medical aid is going to cover just about everything you hold in front of you!” At this Suzie felt the corner of her mouth edge upward. “I see that smile Suzie Q, out with it” said Sarah. Suzie related to her mom how she was becoming accustomed to hearing about Prescribed Minimum Benefits and it was slowly becoming a source of comfort knowing that no matter which medical aid you were with, you were certain of not being left out to dry when it comes to certain conditions, diseases and situations. “That’s right Suzie, it should be a comfort. In the end I only had to pay a minimal amount, which was easy to bear.”

After a lovely meal and long discussions Suzie realised that she was starting to feel a weight lift from her shoulders each time she spoke to someone about the medical aid questions that terrified her. And, each time a little of that weight was lifted “Prescribed Minimum Benefits” had something to do with it.

Suzie now felt the need to know more about the other end of the scale... what would happen if you didn’t have a medical aid? For this she could only think of two people who might be able to answer that question: Jay and Deborah who were in a terrible accident the year before and didn’t have medical aid at the time.