in-hospital and out-of-hospital tests (on discovery)

techead

Honorary Master
Joined
Apr 11, 2008
Messages
12,188
Right.. so following on from my previous thread...

Went to the Surgeon yesterday, and he wants to do some tests before he whips my gallbladder out. He said he would like to be 100% sure.

Apparently the enlarged spleen and weight loss is enough for him to justify a CT Scan of my abdomen, and a gastroscopy (scope down the throat).

The Gastroscopy is classified as a "out-of-hospital" procedure, as I'm having it in the actual doctors rooms, and not in the actual hospital where they put you under. On my plan, Discovery Coastal Core (no savings) they cover the OUT-of-hospital one and not the IN-hospital one. I thought this was weird, but apparently its to stop people from booking into hospital for this procedure when its really not necessary. Or so they say.

Then the CT scan. Discovery are a dodge crowd. You have to be so careful. I've been sent to Morton & Partners to have the CT scan done, and I called them to ask what they are "classified as". They confirmed that they are definitely OUT-of-hospital and that anything done by them, is not covered by my plan.

If I get admitted, and the CT scan is linked to the approved gallbladder op, then it's covered. So just because Im going to Morton & Partners, its not going to be covered and now I need to find +-R7500. My gap cover is useless, as that also requires me to be admitted.

My question : Is it possible to get the doctor to admit me to hospital, even for half day so I can take advantage of the cover as then it will be classified as a IN-hospital procedure?
 

Claymore

Executive Member
Joined
Jan 20, 2004
Messages
8,342
Almost certainly, you still won't be covered. The coverage is determined by the procedure, not by whether or not it's actually in the hospital, no matter what it's actually called. For example, my daughter's jaw surgery was considered as an out-of-hospital dental procedure.
 

techead

Honorary Master
Joined
Apr 11, 2008
Messages
12,188
Almost certainly, you still won't be covered. The coverage is determined by the procedure, not by whether or not it's actually in the hospital, no matter what it's actually called. For example, my daughter's jaw surgery was considered as an out-of-hospital dental procedure.

Coverage is most certainly not limited to the procedure only. If that was the case, they would not distinguish between in-hospital and out-of-hospital coverage...

https://www.discovery.co.za/portal/...scovery_health/do_we_cover/m/mri_and_ct_scans
 

yebocan

Honorary Master
Joined
Sep 22, 2005
Messages
14,008
ahhhh..had a CT scan last year....at the very same Morton & Partners...I am also on Discovery, Coastal Saver...the first R 2500 I had to cover ...the rest the medical aid scheme picked up...all in all they covered around R6500.00
 

Pitbull

Verboten
Joined
Apr 8, 2006
Messages
64,308
Right.. so following on from my previous thread...

Went to the Surgeon yesterday, and he wants to do some tests before he whips my gallbladder out. He said he would like to be 100% sure.

Apparently the enlarged spleen and weight loss is enough for him to justify a CT Scan of my abdomen, and a gastroscopy (scope down the throat).

The Gastroscopy is classified as a "out-of-hospital" procedure, as I'm having it in the actual doctors rooms, and not in the actual hospital where they put you under. On my plan, Discovery Coastal Core (no savings) they cover the OUT-of-hospital one and not the IN-hospital one. I thought this was weird, but apparently its to stop people from booking into hospital for this procedure when its really not necessary. Or so they say.

Then the CT scan. Discovery are a dodge crowd. You have to be so careful. I've been sent to Morton & Partners to have the CT scan done, and I called them to ask what they are "classified as". They confirmed that they are definitely OUT-of-hospital and that anything done by them, is not covered by my plan.

If I get admitted, and the CT scan is linked to the approved gallbladder op, then it's covered. So just because Im going to Morton & Partners, its not going to be covered and now I need to find +-R7500. My gap cover is useless, as that also requires me to be admitted.

My question : Is it possible to get the doctor to admit me to hospital, even for half day so I can take advantage of the cover as then it will be classified as a IN-hospital procedure?

This I could never understand...

For a Colonoscopy you need to be put under. But having something shoved down your throat you can have it while awake :confused: I can easily lay on my side with a small device up my arse and feel no discomfort. The scope is pretty small. I will not be able to swallow a tube down my throat. NEVER!
 

techead

Honorary Master
Joined
Apr 11, 2008
Messages
12,188
ahhhh..had a CT scan last year....at the very same Morton & Partners...I am also on Discovery, Coastal Saver...the first R 2500 I had to cover ...the rest the medical aid scheme picked up...all in all they covered around R6500.00

That R6500 came out of your savings though, right?
 

techead

Honorary Master
Joined
Apr 11, 2008
Messages
12,188
Nope, the R2500, that I had to cover came from my available savings...-the rest Discovery covered...

that doesnt add up. M&P are definitely out-of-hospital and Discovery clearly state on my plan that its not covered at all.

Perhaps they changed it for 2014 :(
 

yebocan

Honorary Master
Joined
Sep 22, 2005
Messages
14,008
that doesnt add up. M&P are definitely out-of-hospital and Discovery clearly state on my plan that its not covered at all.

Perhaps they changed it for 2014 :(

I am on Coastal Saver, you on a Core option...I checked Core plans does not cover CT scans....
 

techead

Honorary Master
Joined
Apr 11, 2008
Messages
12,188
I am on Coastal Saver, you on a Core option...I checked Core plans does not cover CT scans....

makes no sense to me why Coastal Core doesnt and Coastal Saver does. From my understanding the premium is identical, just that the extra goes into a "savings account"

ai... :(
 

durbandave

Senior Member
Joined
Sep 8, 2006
Messages
856
I went for an MRI the other day which I think Discovery treats the same. The first R 2450 came out of savings, the rest was covered by the scheme. My Complimed Gap Cover reimbursed the full co payment which came out of the savings, so all in all not a cent was paid by myself.
 

yebocan

Honorary Master
Joined
Sep 22, 2005
Messages
14,008
makes no sense to me why Coastal Core doesnt and Coastal Saver does. From my understanding the premium is identical, just that the extra goes into a "savings account"

ai... :(

Believe me, there seem to be no real logical when it comes to Discovery....-
 
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