Discovery - Miscommunication

TL;DR - Hospitalized,under the impression that discovery covers these fees.The Dr isnt part of the scheme so they wont pay in full,but I was never informed as such,who should have told me?
 
Unfortunately that is quite correct. Specialists don't have to work at the accepted medical aid/hospital rates, which means you are liable for the outstanding balance. This is why it is very important to maintain both a medical aid and gap cover policy, the latter of which then would cover the difference. (Frustrating situation to be honest).
 
craiglotter said:
Unfortunately that is quite correct. Specialists don't have to work at the accepted medical aid/hospital rates, which means you are liable for the outstanding balance. This is why it is very important to maintain both a medical aid and gap cover policy, the latter of which then would cover the difference. (Frustrating situation to be honest).
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Pretty much. Discovery will cover emergency in full ( which was your 24hrs ) but you need to ensure that the Dr treating you thereafter is on Discovery Rate if you expect them to be covered in full. Otherwise, it becomes your responsibility to find one who does or negotiate with the current doctor. Gap does make it much easier but be warned, this is now restricted to 150k per family per annum whereas before was much much more ( 3mil a person )
 
Thanks guys,was just curious.So it was my responsibility to check with the Dr in that case.Seems a bit odd though that the patient has to find out if the DR is part of the scheme.In my instance i was sedated for the most of the first 24 hours so I couldn't really check.Is there a disclaimer somewhere that states this? I know I have to pay up,however if I was not in a position to negotiate,who would decide if the DR not covered by medical aid rates would assist me?or is that a non issue and people are expected to have gap cover or just pay up?
Regarding gap cover,do you guys have any recommendations?
I know its after the fact but I guess its something I should keep in future
 
animehero said:
Thanks guys,was just curious.So it was my responsibility to check with the Dr in that case.Seems a bit odd though that the patient has to find out if the DR is part of the scheme.In my instance i was sedated for the most of the first 24 hours so I couldn't really check.Is there a disclaimer somewhere that states this? I know I have to pay up,however if I was not in a position to negotiate,who would decide if the DR not covered by medical aid rates would assist me?or is that a non issue and people are expected to have gap cover or just pay up?
Regarding gap cover,do you guys have any recommendations?
I know its after the fact but I guess its something I should keep in future
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Ambledown is good but pretty much everyone has a product and the recent law changes make it the same for everyone.
 
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