Discovery hospital plan + gap cover

J

James 77

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Hi Guys. I’m on Discovery Classic Smart hospital plan. (Thinking of moving to delta as there is only 1 doc in town that is in the network

I have to go to the doctor this week (and then an ultrasound) for some tests. I’ve never been for one so I’m unsure how it works.The classic smart plan only covers Netcare in town and not medi clinic. The day clinic is at medi clinic. I know the day clinic does get covered even though the hospital doesn’t.

so my question is, where would an ultra sound be done ? The day clinic/or doctors consulting room ?

I’m also considering getting gap cover. Would it be better to just get basic gap cover or to get gap cover + supplementary gap cover ?(would be 15% cashback for me as I don’t have car insurance at Discovery)

Thanks
 
James 77 said:
Hi Guys. I’m on Discovery Classic Smart hospital plan. (Thinking of moving to delta as there is only 1 doc in town that is in the network

I have to go to the doctor this week (and then an ultrasound) for some tests. I’ve never been for one so I’m unsure how it works.The classic smart plan only covers Netcare in town and not medi clinic. The day clinic is at medi clinic. I know the day clinic does get covered even though the hospital doesn’t.

so my question is, where would an ultra sound be done ? The day clinic/or doctors consulting room ?

I’m also considering getting gap cover. Would it be better to just get basic gap cover or to get gap cover + supplementary gap cover ?(would be 15% cashback for me as I don’t have car insurance at Discovery)

Thanks
Click to expand...
Ultrasounds can be done pretty much any where, it's a pretty basic procedure, so just go wherever you are able/afford. From what I previously saw of Discovery's gap, I'd avoid with a barge pole. Ours is with complimed but go compare the options and speak to a proper advisor.
 
My 2c: I don't have any faith in the concept of gap cover at all.

Medical service providers use it as an opportunity to price-gouge. You can pay more, so they charge more. If you need a procedure which isn't fully covered by the hospital plan (I'm also on Smart Classic FWIW) then I've never come across any practice who wasn't willing to negotiate the price. Especially if your medical aid already covers much of the fee. If you have gap cover though - no ways, they'll charge as much as they can.
 
newby_investor said:
My 2c: I don't have any faith in the concept of gap cover at all.

Medical service providers use it as an opportunity to price-gouge. You can pay more, so they charge more. If you need a procedure which isn't fully covered by the hospital plan (I'm also on Smart Classic FWIW) then I've never come across any practice who wasn't willing to negotiate the price. Especially if your medical aid already covers much of the fee. If you have gap cover though - no ways, they'll charge as much as they can.
Click to expand...
You don't need to tell anyone you have gap. It's not part of your medical aid and not something that can be looked up. It's short term insurance.

Is useful to have, saved me massive bills years ago, before the cap as well. Yes, you may have gougers but there are some times when you may really need it,especially specialists.
 
Kosmik said:
You don't need to tell anyone you have gap. It's not part of your medical aid and not something that can be looked up. It's short term insurance.

Is useful to have, saved me massive bills years ago, before the cap as well. Yes, you may have gougers but there are some times when you may really need it,especially specialists.
Click to expand...
This is a fair point. If you do want to get it, then just pretend that you don't have it. On principle I'd try to negotiate a better rate with whatever service provider you encounter anyway.
 
Kosmik said:
Ultrasounds can be done pretty much any where, it's a pretty basic procedure, so just go wherever you are able/afford. From what I previously saw of Discovery's gap, I'd avoid with a barge pole. Ours is with complimed but go compare the options and speak to a proper advisor.
Click to expand...

Thank you for the information. Hopefully this specific doctor can do it at his consultation room
 
newby_investor said:
My 2c: I don't have any faith in the concept of gap cover at all.

Medical service providers use it as an opportunity to price-gouge. You can pay more, so they charge more. If you need a procedure which isn't fully covered by the hospital plan (I'm also on Smart Classic FWIW) then I've never come across any practice who wasn't willing to negotiate the price. Especially if your medical aid already covers much of the fee. If you have gap cover though - no ways, they'll charge as much as they can.
Click to expand...

Thank you. How has the Smart Classic been for you ? It has nice d2d benefits. But I’ve been thinking of changing to the Delta. In the city where I live the smart network is very poor. 1 doctor and the Netcare hospital.

Have you ever gone for an ultra sound and if so did the hospital plan cover it ?
 
Kosmik said:
You don't need to tell anyone you have gap. It's not part of your medical aid and not something that can be looked up. It's short term insurance.

Is useful to have, saved me massive bills years ago, before the cap as well. Yes, you may have gougers but there are some times when you may really need it,especially specialists.
Click to expand...

Thanks do you have discovery gap ?
 
James 77 said:
Thank you. How has the Smart Classic been for you ? It has nice d2d benefits. But I’ve been thinking of changing to the Delta. In the city where I live the smart network is very poor. 1 doctor and the Netcare hospital.

Have you ever gone for an ultra sound and if so did the hospital plan cover it ?
Click to expand...
Smart Classic has been ok for me - It was the cheapest option for my family (even cheaper than Core). The day-to-day stuff is just a bonus, we go to the doctor so seldom that it doesn't make a difference. Fortunately we have pretty good coverage in Smart network where we live, so it turned out to be the most sensible choice. If that weren't the case I might have considered Delta. I'd need to look at the numbers again.

My wife's ultrasounds during pregnancy were covered as part of the maternity benefit. But otherwise they will likely not be covered unless you're actually admitted to hospital.

That being said, I've had them done for my son after a potential head injury (came back all clear thank goodness) and they weren't prohibitively expensive. It was under R1000 IIRC. So not exactly cheap enough that I'd do it on a whim, but also didn't put me in doubt of whether I was going to be able to afford groceries.
 
newby_investor said:
Smart Classic has been ok for me - It was the cheapest option for my family (even cheaper than Core). The day-to-day stuff is just a bonus, we go to the doctor so seldom that it doesn't make a difference. Fortunately we have pretty good coverage in Smart network where we live, so it turned out to be the most sensible choice. If that weren't the case I might have considered Delta. I'd need to look at the numbers again.

My wife's ultrasounds during pregnancy were covered as part of the maternity benefit. But otherwise they will likely not be covered unless you're actually admitted to hospital.

That being said, I've had them done for my son after a potential head injury (came back all clear thank goodness) and they weren't prohibitively expensive. It was under R1000 IIRC. So not exactly cheap enough that I'd do it on a whim, but also didn't put me in doubt of whether I was going to be able to afford groceries.
Click to expand...

Thank you for the advice. It’s the same for me. I haven’t been to the doc in years. And it’s only me on the hospital plan. So the day to day benefits is actually irrelevant in my case. And as it’s limited to one doc in a big city then it’s just a waste
 
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