Specialists charging discovery DOUBLE??

T

travcaine

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Hi there,

I came across something very upsetting with my hospital admission. My neurologists sent me a statement for their services, but I noticed that they are claiming from the wrong medical aid (Medihelp) the total for this Statement was R6100. I sent them a mail stating my correct Discovery details and then sent the statement again, all of the sudden the total is now nearly double at R11900!!

Is this normal, is it something that happens? Surly it cannot be? Really would like to hear some comments on this, I have also attached both statements for your benefit.

View attachment DISCOVERY.pdf
View attachment MEDIHELP.pdf
 
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Maybe medihelp only pays half of Discovery's rate..?
 
Yeah it's normal for specialists to charge the max rate your medical aid will pay. It's morally wrong in my opinion but what you going to do about it?
Medical in this country is very good, but the administration of it is just wrong.
Medical aids need to do something about this.

Oh and some specialists won't even deal with medical aid, they charge 3x the normal medical aid rate (also referred to as discovery platinum rates) which you have to pay them directly and claim whatever pittance your medical aid will cover (usually about half).
 
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reactor_sa said:
Yeah it's normal for specialists to charge the max rate your medical aid will pay. It's morally wrong in my opinion but what you going to do about it?
Medical in this country is very good, but the administration of it is just wrong.
Medical aids need to do something about this.
Click to expand...

This is so crazy!
They do need to do something
 
That's pretty shocking, I'd love to know how they explain this discrepancy.
 
reactor_sa said:
Yeah it's normal for specialists to charge the max rate your medical aid will pay. It's morally wrong in my opinion but what you going to do about it?
Medical in this country is very good, but the administration of it is just wrong.
Medical aids need to do something about this.

Oh and some specialists won't even deal with medical aid, they charge 3x the normal medical aid rate (also referred to as discovery platinum rates) which you have to pay them directly and claim whatever pittance your medical aid will cover (usually about half).
Click to expand...

This is the reason why a thing like gap cover exists. It's criminal in my opinion, but it happens. I think the doctors are the reason medical aids are so full of kek
 
reactor_sa said:
Just don't tell them you have gap cover, if they know they'll charge you $$$$$$²
Click to expand...

I dunno. I even asked my neurosurgeon if I'd need my gap cover for the op I just had. He said no. Discovery paid every cent.
 
I would ask Discovery to explain how it is that you are charged double if using them as a medical aid. If it's all above board they can explain why, if not they can hopefully investigate.
 
And now you know why your medical aid has 10% plus hugely increases. The get fleased by specialists especially when it is a PMB where they are forced to pay everything by law.
 
C4Cat said:
I would ask Discovery to explain how it is that you are charged double if using them as a medical aid. If it's all above board they can explain why, if not they can hopefully investigate.
Click to expand...

I am going to send it off to them as well and ask.
 
Blu82 said:
And now you know why your medical aid has 10% plus hugely increases. The get fleased by specialists especially when it is a PMB where they are forced to pay everything by law.
Click to expand...

Yup, won't need to ask the "Why is discovery so expensive?" question again.
 
reactor_sa said:
Yeah it's normal for specialists to charge the max rate your medical aid will pay. It's morally wrong in my opinion but what you going to do about it?
Click to expand...

Receptionist: I'd just like to confirm whether you are still on medical aid X and gap cover plan Y?
Me: yes to medical aid, no to gap
Receptionist: Oh good thing I called you then, I'll give you the lower rate
Me: .......

Real conversation from my last stay in hospital
 
Archer said:
Receptionist: I'd just like to confirm whether you are still on medical aid X and gap cover plan Y?
Me: yes to medical aid, no to gap
Receptionist: Oh good thing I called you then, I'll give you the lower rate
Me: .......

Real conversation from my last stay in hospital
Click to expand...

Seems I have one of the few ethical specialists around?
 
reactor_sa said:
Maybe he/she already bought a new Porsche that month
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You joke. He has a collection of classic cars. When we were talking about my options, he said "We'll try conservative treatment for two months. If you have no relief, then I'll buy myself a new Mercedes"
 
It's criminal but since no one ever does anything about it they get away with it. And then your medical aid gets more expensive and you don't understand why.

My wife had a similar incident. She had a procedure a couple months ago, and was told it's not covered by medical, had to pay out of her own pocket. She got a statement in the post from the medical aid, who paid the exact same invoice, but 3 times more than what my wife was invoiced for. So the corrupt doctor got 4x the amount for which they initially claimed. When we approached them they just denied it and said it was an error. No one got refunded though.
 
And people still treat these scum bags like gods. I treat a doctor no better or worse than my mechanic or garden executive.
 
ambroseg1 said:
And people still treat these scum bags like gods. I treat a doctor no better or worse than my mechanic or garden executive.
Click to expand...

Yes. They're dogs. And if you're not on the top plans you might as well not have medical aid at all.
 
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