Friday, September 18, 2009

The reality of twins - part 2 - medical expenses

Getting ready for my egg retrieval on IVF cycle 2 - got 5 eggs - pic taken at 7:01am (we had to be there at 7am) on 8 Dec 2008.

First of all, thank you all SO VERY MUCH for the great comments on my previous post.

They have helped me tremendously and I've been referring all my friends to the post, just to read the comments :)


I've been threatening to do a post on money for some time so here goes. Maybe this will help me come out of denial because I've been procrastinating doing the budget (not normally me) because I'm so scared of seeing the numbers.

Right, so with twins there's always the added bonus of them arriving early. I didn't know this beforehand but prem babies have a whole other set of expenses.

Before I detail them, let me explain something. In South Africa you're either on a medical aid (medical insurance) or not.

If not, you go to a government hospital. Shocking facilities - you seriously don't want to ever be in the position of having to go to one of these. (Aside - I remember when we joined our medical aid years ago, they took forever to send us the stickers for the car saying in the event of an accident, we are members of such and such.... I almost screamed at the call centre agent saying "if I'm involved in an accident, I do not want them throwing me into the Joburg Gen" - it's that horrific) .

So I think this is correct (as my work involves a project to do with health care) but only about 4 - 5 million of the 43 million South Africans actually have medical insurance. Something like that. Which entitles you to go to a private hospital.

procedure room at hospital where I had horrible internal examinations
to check dilation and so forth *shudder*

We are on a plan that offers unlimited hospital cover but very minimal day to day cover.

Of course most medical aids in South Africa don't cover any fertility treatment so the R100 000 we spent last year was also out of pocket. I think there are two tiny medical schemes that pay something toward fertility treatments. Maybe someone who knows more will comment???

The way it works on my medical aid is a portion of your monthly premium (but not more than 25%) goes into a savings account which pays for the day to day expenses of doctors, pharmacy, etc. The rest of the premium goes toward risk (hospitalisation).

I'm in insurance (life and short-term) and I'm amazed at how people don't think about these things properly.

For example, if we had to go onto a better day to day plan, we'd pay over R2000 extra every month (it was R1800 just for D & M, pre-babies this year). Your savings portion doesn't increase by R2000 obviously, only about R400 - R500. So my thinking is why don't you just save that extra R1800 and take your chances?! See I know how these things are rated and I'm the type of person who likes the lowest monthly expenses but doesn't mind an occasional big expense.

You can see that there's really no point in us moving toward a better plan - it would pay for one paed appt and then we'd still have to pay the rest.

And thank the Lord for medical aids because my bill for the Caesar and 3 days was R23 000, Connor's bill for 16 days was R77 000 and Kendra's was R93 000. And that's besides the blood tests and specialist doctors - billed separately but all paid.

Because the babies were prem, they have to make sure that everything that should have developed until term (nerves, blood vessels and what not - I really don't listen very well these days - I'm too sleep deprived) has developed properly and was not damaged in some way.

Now these are God's kids so I know they're fine but you still have to go through the motions to get the official say-so. Oy!

Eye doctor
Fortunately Kendra was in NICU when he first saw her (covered by medical aid - everything in hospital is covered on our plan) but Connor had to go once discharged. R398 for all of 5 minutes.

They then had a follow-up appt at their actual due date (R398 X 2 = R796) and need to go again 4 weeks from then (another R398 X 2 = R796).

He said to me that "hopefully that will be the last".

Hopefully indeed!

Ear doctor
My hospital offers an initial screening at birth (R250 per baby) but mine were in NICU so we missed out. We were about to get Connor's done when we were out and my clever husband happened to ask if any additional tests were needed. Yes, because they're prem. Grrr.

So we decided to forgo the initial screening and get the whole bang shoot done together to save paying two sets of consultation fees.

I eventually took the babies on Tuesday. R900 X 2 = R1800

Normal paediatrician visits
They both went two weeks after discharge, and then four weeks after that.

R450 X 2 X 2 = R1800

Remember most of these specialists charge WAY above the rate legislated by the medical schemes act.

E.g. our paed's consultation fee is R450 - the medical aid rate is R350 so you're out of pocket R100.

Of course we pay for ALL these things out of pocket because our medical savings account ran out in Feb already.

At our hospital babies get the first vaccination for free as part of the mother's hospital booking fee.

I've just checked their cards and babies should get 6 in their first year.

So I phoned to make an appointment and I was horrified.

The cheapest vaccinations I could find was R1275 per baby. I made the appointment at the cheapest place and we (nanny and I) took the babies yesterday.

(Interesting - apparently 60% of kids in South Africa die from some form of pneumococcal virus, whatever that means, but it was scary enough for me to say "go ahead, jab them!")

It actually came to R2600 because they also charge a fee to administer the injection.

Next shots are in 4 weeks time - R970 each - and ones after that are in another 4 weeks time, again R1275 each.

So over the space of two months I'll have spent R7 140 just on vaccinations!

Add the other medical appts and by the beginning of November (4 months after their birth) the grand total of medical appointmens is a whopping R13 630.

That's besides

any medication I get at the pharmacies...




night nanny.....

My word, that's scary. But thank goodness, I am firmly out of denial now :) Although the only things budgeted for were formula, nappies and nanny.

I read on a blog this week that someone in the US had to pay $6 000 in hospital costs for a Caesar because her insurance only covered a bit. Now $6 000 is R45 000 which is nearly double what the hospital charged for me to have the babies. I paid an extra R7 500 for the doctor but still frightening!

So tell me, what is the situation with medical aids in your part of the world? Are you covered for your fertility treatments (if you underwent anything), hospital for births, NICU costs, etc.


  1. Anonymous3:15 am

    We are fortunate to have good medical insurance here in the US. We did not pay anything out of pocket for the hospital stay/delivery and all doctor's appointments are $10. However, we had no coverage for fertility treatments and spent $25,000 on our IVF cycle (we did shared risk, so it was more expensive but we had 6 attempts for that price. We were successful our first try).

  2. Hi Leigh,
    Come to the land of the good looking cricket team, short summers & fish and chips :) I didn't need fertility treatment but many friends have & the first cycle (or perhaps 2) are free if you meet the criteria - not financially based, just on health, age etc. NICU is F R E E as was my highly medically managed, complicated pregnancy that required lots and lots of medical TLC and expensive (free to us) drugs. All up the pregnancy cost us the opportunity cost of my salary because I had to finish work at 28 weeks, the cost of coffees in the hospital cafes, parking!, a breast pump and hireage of a hospital grade one for a while, and gifts for hospital staff. All in all - cheap as chips compared to your experience. Just for the record, the public health care system here isn't always so amazing - we have private medical coverage too - it's just that high risk/prem baby related stuff is just so wonderfully catered for if you need it. One struggles to begrudge paying taxes here when such a good service is accessible to all.

  3. I am one of the fortunate people who did have fertility coverage. As with the rest of our medical insurance, we had to pay 10% of all costs until we reached our premium for me which was $1,500 out of pocket every year.

    We had to pay 10% of procedures for the boys as well until we reached our premium. I reached mine early on because of the pregnancy, but once the boys were born, they had to reach their premium which is $1,500 each.

    We're still getting bills for the boys' birth which was back in June. In August we paid out almost $1,000 in medical! To date, in September, we're up to $800. It's crazy, but we're lucky to have good care.

    God Bless :-)

  4. I think I'll post about this's going to take me a while to figure out the combined costs!

  5. You realize you're touching on a hot topic for those of us here in the U.S., right?? : )

    We are blessed to have great medical insurance. The total I paid out-of-pocket during my pregnancy (no fertility treatments or anything like that) was under $200.00. Our insurance fully covered my $19,000 c-section, the babies' NICU monitoring (just a few hours, but over $1,000 each), hospital stay, etc. It makes me very appreciative of what we do have, and for the record, I think it needs to be more accessible for those who are not as lucky!

    As far as pediatrician visits, we pay a $50 co-pay ($25 per child) for visits...which stinks right now that they are going every few months, but won't be so bad when it's once a year or so. No extra cost for vaccines. I'm glad you are able to pay the additional cost to get them for your babies!

    Great post!!

  6. I have to say we're one of the lucky American families that have good health insurance. Granted we picked it very carefully. Our previous insurance covered infertility treatments, except a $30 copay for each visit.

    Our babies were premature and our insurance covered their 6 weeks in the NICU. We had to pay $250 per baby for their hospitalization and $250 for me from the delivery. I've seen the statements from the insurance company and the NICU stay was over $100,000 per baby! I feel very lucky!

  7. Hi

    Very informative post. I usually read your post.. Keep blogging.


  8. Nice post i really glad to read this informative post, thanks to share :)

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