A local medical aid scheme Symphony Health, is said to be in financial woes that have resulted in major medical service providers cutting ties with the organisation, Botswana Guardian has established.
Investigations by this publication have revealed that the organisation’s clients are failing to access medical help, as the organisation owes some of the service providers undisclosed amounts of money. In fact the company has admitted through an email leaked to this publication dated 10th August 2017 that it has temporarily suspended its accounts at Bokamoso Private Hospital and Gaborone Private Hospital.
Information gathered by Botswana Guardian indicates that Symphony Health clients have since last week been turned back by pharmacies when presenting their prescriptions because the Scheme has not settled its debt.
Symphony Health is an open/private medical aid scheme registered in April 2013 as a Trust and started operating in May 2013. The Scheme is administered by Symphonic (Pty) Ltd.
The scheme prides itself in being a new generation medical aid and the only one of its kind in Botswana. According to its website, a new generation medical aid scheme is one that offers a Risk Pool from which “uncontrollable” cost (such as hospitalisation) will be paid and “Medical Savings Account” from which “controllable” or day-to-day expenses (such as GP visits and medicines) will be paid for.
On a monthly basis, 75 percent of a member’s (and their dependants) premium goes towards the Risk Pool and 25 percent goes towards the Medical Savings Account. Botswana Guardian has however established the company’s clientele base.
“Following our previous email regarding the temporary suspension of the Bokamoso Private Hospital (BPH) account, we regrettably wish to update as follows: a) we had previously expected the BPH matter to be resolved within a short period of time. Regrettably this has taken a relatively longer time and is still unresolved, though we are working on a solution. b) We have since had the GPH account also temporarily suspended and have been working with the GPH to get the matter resolved within a reasonable time. It is our desire to get the GPH reinstated at the earliest and are working with the hospital to achieve this ASAP,” reads an email from the company’s Client Service department seen by this publication.
It has also been admitted that through the same communication to the clients that the company is generally behind with claims payment to Service Providers and this is presenting access challenges to members.
“This is a situation that is regrettable and has been caused mainly by huge claims incurred by Members with over 50 percent going into private hospitals. We have observed that a few Members incur huge hospital admissions too frequently in a short space of time and in other instances Members utilise the services of the private hospitals or specialists where lower level of care is necessary. Such kind of healthcare seeking behaviour results in unnecessarily high expenses that could be avoided,” the company noted.A source who is a client at the Scheme has revealed that they have been sent from pillar to post when they try to enquire. “The sad part is wherever they recommend you to go to that particular service provider would tell you that they are being owed and there is no how they could assist. My fear is that Symphony might close shop very soon without notifying us and we would have lost out big time,” said the source.
The scheme has cried out to its members to help them to manage the claims costs by making the right decisions. It has indicated that in the interim, the scheme is working on a solution that will ensure that all the claims’ backlog is cleared and that unfettered access to private healthcare is available to Members going forward. It has emerged that some of the facilities suggested to be used for emergency services in the interim, whilst the scheme is sorting the GPH & BPH matter, are also turning back the clients. Efforts to get a comment from Symphony Health were futile as their office line was not answered while a visit to their head office to solicit a comment could not assist as it has been locked since Monday this week.