The crippling cost of falling ill

If something happens to you, it is not in your best interests to go to a state facility

If something happens to you, it is not in your best interests to go to a state facility

Life can change completely with one phone call. 

Mine did on July 2 when a stranger rang and said: “Don’t panic, but Steve has been rush into hospital unconscious.” I panicked. 

Steve is my boyfriend, and I’d kissed him goodbye two days earlier when he flew to Richards Bay on business.

The diagnosis came quickly — sinus problems had caused an infection that in turn triggered meningitis, the killer bacterial variety.  

The horror of watching someone you love strapped to a bed writhing in agony as a battle rages in his head is indescribable. Then, as he started to recover, a series of strokes overnight left him paralysed and comatose.

It’s frightening enough that sinus problems can cause meningitis. It’s also scary to think what would have happened without medical aid. I’ve seen the bills, and they are not the stuff that ordinary people are made of.

Steve was paying R2 141 a month to Profmed, quite a high level of cover because he wanted enough day-to-day benefits to cover sinus and hypertension.

It was the best investment he ever made, because the bills racked up in the past few months are astronomical.

Almost six weeks in The Bay Hospital – R850 000

The bill came in two parts, starting with a 46-page document detailing every swab, every injection and totalling R610 687. Twice I had stood surety for emergency brain scans at R13 000 each, hoping Profmed would cover the bill later. It did.

Profmed paid R576 768 of the total, leaving us with a shortfall of R33 919. Luckily the hospital was open to negotiation.

Consultations by the neurologist, neurosurgeon, anaesthetist and the laboratory fees were charged separately. Their bills of another R245 000 were at medical aid rates, so Profmed paid. 

Six weeks in ICU in Milpark – R150 000

Steve’s company paid for a medical evacuation to Milpark Hospital back in Johannesburg. The neurologist there charges more than double the rate approved by Profmed, so each consultation accrued a shortfall. His daily visits left a payment gap of R47 000. I haven’t received that bill yet – it’s probably in the post.

Sub-acute centre – About R88 000 a month, including rehabilitation

When Steve finally regained conscious he was moved to Clayton House, a sub-acute rehabilitation centre. They requested 10 weeks of funding, but Profmed granted four. Profmed also picked up another R9000 in laboratory fees. We paid privately for 10 more days, and then moved him to a far less costly frail care facility. 

Without medical aid, Steve may have died. Yet it’s easy to be angry and puzzled that the funds have run out, though he remains in a precarious condition. Medical aid will not pay for ongoing frail care, yet he is fully dependent on 24-hour assistance.

His choice of medical aid package had no financial limits for hospital stays, but funds for rehab are limited to two months or a fixed monetary amount, which we exceeded, says Profmed’s scheme manager Beverley Carrozzo. 

“Profmed is one of the few medical schemes that offers rehab, and it’s quite a rich benefit,” she says. “We are very aware that paying medical aid contributions is a grudge buy for most people, but it’s just one of those things you can’t afford not to have. 

“Unfortunately we all know the conditions of the state hospitals and if something happens to you, it’s just not in your best interests to go to a state facility,” Carrozzo says. “Even if you only have hospital cover at least you are covered for the big ticket items, and you can take care of the day-to-day things yourself.”

Serenity Frail Care Centre, with its brilliant nursing, costs about R15000 a month. Bills for the ambulance to move him, a R15 000 wheelchair, the doctor on call and his medications are being paid for privately, along with physio, speech and occupational therapy. 

He needs these to have any chance at all of regaining a tolerable quality of life. 

Medical aid may have run out, but so far, my hope still hasn’t.