A (possibly another) medical aid thread

Agent_Smith

Agent_Smith

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So I think I've finally had it with Discovery Medical Aid. I've been with them since about 2000 or 2001 and they're just not the company they were (in my eyes anyway).

I'm paying just over R3k per month for a Coastal Core plan with Gap Cover. Much to my chagrin, I discovered (excuse the pun) a year or two ago that even going into the Mediclinic to have a dislocated shoulder reset wasn't fully covered. I didn't need some life saving procedure nor did I even spend the night so I would have liked to believe that my medical aid plan would've covered this. Evidently not. Another frustrating experience was my recent Vitality assessment where I was denied my maximum points due to my blood pressure being too high. The threshold is about 120/80 and I came in at 115/80. So because the diastolic BP (80) was on par, the entire section of that part of the assessment was dismissed. Their reasoning when I spoke to them was that it was a 'business rule' and they were 'sorry for the inconvenience'. Their lack of understanding or flexibility on this is what irked me.

Anyway, I am definitely open to suggestions from forumites. I was also wondering whether there are such things as medical aid brokers that, much like insurance brokers, will 'shop around' for policies and present a range of options. I understand though that individuals' medical needs are vastly different to their automobile and household insurance needs so it may not be as clear cut.

So hit me with some suggestions or phone numbers of people to call.

Apologies for any duplicate thread. I did a medical aid search but nothing came up.
 
Agent_Smith said:
So I think I've finally had it with Discovery Medical Aid. I've been with them since about 2000 or 2001 and they're just not the company they were (in my eyes anyway).
Click to expand...
I stopped using them in the early 2000's. Gave me nothing, but grief. :thumbsdown:
 
Agent_Smith said:
So I think I've finally had it with Discovery Medical Aid. I've been with them since about 2000 or 2001 and they're just not the company they were (in my eyes anyway).

I'm paying just over R3k per month for a Coastal Core plan with Gap Cover. Much to my chagrin, I discovered (excuse the pun) a year or two ago that even going into the Mediclinic to have a dislocated shoulder reset wasn't fully covered. I didn't need some life saving procedure nor did I even spend the night so I would have liked to believe that my medical aid plan would've covered this. Evidently not. Another frustrating experience was my recent Vitality assessment where I was denied my maximum points due to my blood pressure being too high. The threshold is about 120/80 and I came in at 115/80. So because the diastolic BP (80) was on par, the entire section of that part of the assessment was dismissed. Their reasoning when I spoke to them was that it was a 'business rule' and they were 'sorry for the inconvenience'. Their lack of understanding or flexibility on this is what irked me.

Anyway, I am definitely open to suggestions from forumites. I was also wondering whether there are such things as medical aid brokers that, much like insurance brokers, will 'shop around' for policies and present a range of options. I understand though that individuals' medical needs are vastly different to their automobile and household insurance needs so it may not be as clear cut.

So hit me with some suggestions or phone numbers of people to call.

Apologies for any duplicate thread. I did a medical aid search but nothing came up.
Click to expand...
Adrian thanks you for all your contributions to his third fancy car, Tuscan villa, wife's boob job and kids' overseas extended "study" holidays, as well as his treasures in the drawing room
 
PaulMurkin said:
Adrian thanks you for all your contributions to his third fancy car, Tuscan villa, wife's boob job and kids' overseas extended "study" holidays, as well as his treasures in the drawing room
Click to expand...

I guess if I get a pic of said boobs, I'll consider it even :laugh:
 
/s

Discovery's noose around my neck gets tighter every year
 
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I've been hopping around different Medical Aids for a while now, but I recently settled on Discovery because my employer covers half of the cost every month. It's a sweet deal, but I don't think I would stick with them if I had to pay the full price. Before Discovery, I was with Bonitas, and they weren't great - in fact we ran out of "day to day" funds by August, and we're not chronically sick or injured. Their app and website were a pain to use, and their service was mediocre.

The only Medical Aid that I really liked was a custom one provided by my employer, that got bought out by Bonitas. It had everything I needed and it was affordable. Too bad it's gone now.
 
Most medical plans will only cover 100% hence this being the reason to have gap cover. If the gap cover dis not cover the additional costs charged above medical rates (100%) then perhaps consider changing gap cover to a company like stratum look at their elite package. Works well for us.
 
This would have been exactly the same on every other Hospital Plan (which is what Coastal Core is) as it only covers you being admitted to hospital.

The caveat there is that some gap cover options may have a built in emergency ward cover if it was an accident as was presumably the case here, so I would consider changing only that away from Discovery.

I use Stratum Benefits.

Discovery is still the best of the lot I’m afraid.
 
Discovery is a scam. Dropped them like a hot cake.
Anything else is better.
 
Look to see if your dislocated shoulder injury isn't covered by PMB,
Look at the medical schemes website for PMB codes
it may be covered under
900HOpen fracture / dislocation of bones and jointsReduction / relocation; medical and surgical management"
The link is to an excel sheet with PMB codes that are covered. Otherwise talk to the treating doctors as they know about PMBs but you struggle to get them to use the correct codes, when it is a minor injury, on their accounts.
 
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