Be network-savvy to avoid unexpected healthcare costs


No one likes unexpected costs and extra admin if they can help it, so it makes sense to take advantage of healthcare networks whenever you can. By tapping into network arrangements, you can cut down on unexpected co-payments. Here's how.

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."


Free doctor advice is just a click away

Do you have a niggling symptom? Access high-quality medical information with Discovery DrConnect. Using the Discovery app or website, you now have access to:

  • Ask a doctor: a growing library of over 5 billion doctor-created answers to medical questions - or you can get a personalised answer from a doctor, at no extra cost to you.
  • Health goals: Doctor-created tips and checklists to help you meet your health goals and manage your chronic conditions.
  • Your doctors: Virtual follow-up consultations with participating doctors who you have seen in the last 12 months, using voice, video or text, paid from your applicable day-to-day benefits.

Already a Discovery Health Medical Scheme member? Access this functionality here or download the Discovery DrConnect app now

Related articles


Replace those resolutions! (with small, effective habits that last)

How many times have you made a New Year's resolution to "get healthy" that didn't last a month? Don't worry, we're not judging. Fact is - it's pretty tough to stick to resolutions. And according to behavioural economists, it takes a lot more than sheer willpower.


Fighting healthcare costs through shared-value

In his second opinion-editorial, Dr Broomberg's explains how Discovery Health is using the concept of shared value to fight rising healthcare costs. (Published: Sunday Times, 12 November 2017).


What's driving up our health care costs?

In the first, in a series of opinion-editorial published in Sunday Times and aimed at educating consumers about important matters in the South African healthcare sector, Dr Jonathan Broomberg, CEO of Discovery Health, delves into the key drivers of healthcare costs (Published: Sunday Times, 5 November 2017).

Log in