Discovery and it's hidden clauses are killing me

[Stonemason]

Something I discussed with family and friends at one point, is that even for those who had medical operations and claims, it would have been significantly better for them to take their medical aid contributions over the year and invested them into conservative investments with relatively short periods to release the money (30 days).

The only issue is getting the first ~R200k for that initial safety net.

You can gamble by trying to go the savings route but if a serious illness strikes one or more family members you are in major trouble. Just this year alone, Covid and cancer in my small family cost Discovery more than R700 000. It will take a long time to make up amounts like that by trying to save your medical aid contributions instead of getting a medical aid..

 

[marine1]

Welcome to a medical aid! Its all about the money

THIS !!!!
The sooner we realise all med aids are basically out to make money at your expense / health, the better

 

[Agent_Smith]

Good luck OP. I'm having a similar fight with them. I dislocated my shoulder on Thursday and had to go in to have it relocated. Got a bill from Netcare yesterday and found out that Discovery didn't pay a cent towards it as I'm on a hospital plan, which means I'm only covered if I am booked into hospital into a ward for a scheduled procedure. An 'out-patient' (which is what I was) that has to go to casualty gets no cover on my plan. Now I have to email them casualty reports, xrays etc for them to consider covering it. I wonder what the hell I am paying them over R2k a month for then...

 

[Sanzer]

The essential plan has a lot of exclusions.
Look on page 37: https://www.discovery.co.za/wcm/dis...alth-medical-scheme-smart-plan-guide-2021.pdf

The essential plan seems to be no better than a hospital plan.

 

["D"]

I dislocated my shoulder ...

That part is somewhat true, evidently.

... and had to go in to have it relocated.

Hmmm. You really think that is what has happened to you?

 

[SHL]

You can gamble by trying to go the savings route but if a serious illness strikes one or more family members you are in major trouble. Just this year alone, Covid and cancer in my small family cost Discovery more than R700 000. It will take a long time to make up amounts like that by trying to save your medical aid contributions instead of getting a medical aid..

This is true. Couple years back, a family member had to be admitted and ended up in ICU for a month.....the bill ran over 1 million which the medical aid covered fortunately.

 

[pinball wizard]

I have downgraded to a hospital plan only (building my own savings up). It doesnt help one gets sick, going to the dr, get meds and its all from Savings. Same with teeth.

Of course you can always pay for things without the medical aid?

Like pay the doc cash, or take your script to the pharmacy and pay cash?

People don't think of this. And then you can claim those expenses back from sars.

 

[Rickster]

I'm wanting to switch to a medical aid that covers braces, does one exist that covers it for about R2500 p/m?

Im on discoveries delta saver, so useless.

 

[e4et]

Can you not go to a state hospital to have it done ?

 

[pinball wizard]

I'm wanting to switch to a medical aid that covers braces, does one exist that covers it for about R2500 p/m?

Im on discoveries delta saver, so useless.

Snapshot of the estimated costs of orthodontics​

First consultation, x-rays, diagnostic photos & treatment plan – R 2 600

Outside or labial braces – R25 000

Inside or lingual braces – R42 000

Optional tooth coloured brackets – R2 800 (upper) or R1 800 (lower)

Post-treatment x-rays, photos & retention appliances – R2 900

How medical aid schemes cover orthodontics​

Most medical aid schemes in South Africa do cover part or all of the costs relating to orthodontics. However, the way they pay the benefits differs markedly from scheme to scheme.

For example,

• Discovery Health pays for orthodontics benefits out of your savings account
• Fedhealth covers the cost of pre-authorised orthodontics treatment from your out of hospital benefits and/ or savings component
• Bonitas covers the cost of orthodontics treatment subject to the Denis dental protocols
• Momentum Health pays for pre-authorised orthodontics treatment from your dental benefits
• Medshield covers the cost of orthodontics from your day to day benefits, once pre-authorised. Fail to get pre-authorisation and you’ll be liable for all related expenses.

Medical Aid for Orthodontics

Find out which medical aid schemes cover orthodontics and how you can apply for cover now.

www.medicalaid-quotes.co.za

 

[ghostRgg]

Hi guys sorry I was unresponsive I ended off being rushed to my local dentist which wasn't covered by Discovery.

He hasn't charged me yet since it was quite an emergency. Got prescribed around 5 things and two sets of antibiotics.

Long story short I have an absyss that is leaking and protruding into my upper jaw and sinus. They can't do anything as its too dangerous right now and need it to be less inflamed to work on it.

I have a follow up on Monday where we will discusses the way forward. Stating I will need to be in hospital or day clinic as it requires a maxofacial guy too.

As most people said I am a dumbass not reading everything, but I never expected them to leave out so much. Especially since in-hospital is covered, just not dental work in hospital.

 

[CB40]

All the medical aids, dental and optometry support is terrible.

Guessing hearing will be the same.

You are right,hearing aid cover on Classic Comprehensive is only R21,000.00 if I remember correctly

I had to get two hearing aids so got one the first year and the other the year after.

 

[Polymathic]

I'm on the cheapest plan. It costs over 4k a month for a small family. It's essentially useless for day to day. The affordability scale is a joke too, if you make more than 13k you can expect to pay half that salary for a family.

Almost everybody I know who have medical aid are now paying cash for GP appointments.
My local is now charging R300 for cash patients and R650 for medical aid patients.

 

[Eti1]

It's its.

 

[Sapphiron]

Almost everybody I know who have medical aid are now paying cash for GP appointments.
My local is now charging R300 for cash patients and R650 for medical aid patients.

Same here

Speaking to a doctor, they say it's so much less hassle to collect from you directly vs having to deal with the insurers. They create so much admin work for the practice and you end up paying for admin.

 

[Moto Guzzi]

The new Smart New Norm Medical Aids(Since 1992+) needs a good checkup, and a Great Reset, to resume the "Old Norm" where Medical aids actually ment something and was affordable without plans, and just worked.
Theres an Abstract Zig-Zagging through the plans over Time going on, the catch lies in the "Over Time".
THe money should be strcktly followed till where it fell in the last account.

Today you get two types of corruption:
1-From the bottom up individuals. THis type of corruption is easy and was over many years before digital always dealt with and tolerated.
2-From the top down(Boardroom)...This is a cancer, abstract and difficult to deal with and plain simple unaffordable in the long run. Its sucks money.

 

[Nemesys]

Good luck OP. I'm having a similar fight with them. I dislocated my shoulder on Thursday and had to go in to have it relocated. Got a bill from Netcare yesterday and found out that Discovery didn't pay a cent towards it as I'm on a hospital plan, which means I'm only covered if I am booked into hospital into a ward for a scheduled procedure. An 'out-patient' (which is what I was) that has to go to casualty gets no cover on my plan. Now I have to email them casualty reports, xrays etc for them to consider covering it. I wonder what the hell I am paying them over R2k a month for then...

How does prescribed minimum benefits work?

Prescribed Minimum Benefits (PMBs) ensure that all medical scheme members have access to continuous care for a defined list of conditions to improve their health. Discovery Health Medical Scheme plans are structured in a way that maximises cover no matter which health plan you choose.

Closed fractures/ dislocations of limb bones / epiphyses – excluding fingers and toes are all PMB’s PMB902H

There are 270 PMB that medical aids are by law compelled to fund.

I would seriously consider appealing their decision not to fund the procedure to reset your shoulder

You do have 4 channels available to take your query further

1 Appeal

2 Contact the principal officer

3 Lodge an dispute

4 Contact the council for medical schemes

 

[Kosmik]

CMS is useless.

 

[ScottulusMaximus]

THIS !!!!
The sooner we realise all med aids are basically out to make money

Duh... They're companies, not charity.

Private medical treatment is a luxury, it's not their fault the government has made it a necessity.

 

[ghostRgg]

Sorry been knocked out every time I took my meds, hopefully I can get back to doing some work tomorrow.

Another mess up is the Gap Cover system my family has me on. They will only cover me till age 26 (I am turning 26 in December) if I was studying.

It just ticks me off again, sure I'm not studying but trying to start up my business over the years, but am now "kicked" off the backup gap Cover.

On Monday my plan is to speak to the Dentist and see if he can get pre-authorization to get it done in hospital as a medical emergency, because it really is one.

Last mess up was when my one stomach ulcer started bleeding and I went to ER and got a 2 hour temporary bed, after suffering on the carpark pavement for hours 5 hours, quick medication and treatment, turned around and sent home due to the hospital keeping beds for Covid patients.

Got invoiced for everything since I wasn't "admitted" which is honestly another wtf move. They took 6 vials of blood, then I never heard back from what they did with it or any results.

Please! Can anybody recommend a somewhat decent medical aid scheme. This Discovery Smart Classic is useless.