Why Discovery is so expensive

StrontiumDog said:
I am going for a non surgical procedure in less than 48 hours. I have been trying since last week to find out what I am going to have to pay. The Intercare says they can't tell me what it's going to cost I must phone Discovery. I do so, then Discovery tells me I need the procedure code and practice number from Intercare first. After a couple more calls I get that info and call Discovery back, they tell me their rate for that code but they can't guarantee that the Intercare will charge that rate. Like WTF?! :wtf:

No wonder my old man throws a fit when I ask him to find out beforehand what his various procedures are going to cost before he goes in.
Click to expand...

On the other side of the coin as a private paying patient.

I saw the surgeon on Thursday at 12, got my quote from the hospital at about 15h00. Paid it today and going under the knife tomorrow. (Life Wilgeheuwel Hospital)

Edit: One thing med-aid people dont do is go the extra step in trying to drop the cost. One example My opp is only for tomorrow afternoon, I was suppose to be booked in tonight and pay for 3 days. After 2 phone calls I am only going in tomorrow after 12 so I only need to pay for 2 days instead. Yes its only R3k less but it was worth the 2 calls.
 
Last edited:
Niner said:
I understand that, but a GOOD broker should be able to explain these to you. The biggest scam they came up with is - 'don't worry, we'll cover that 100%, no problem'. That means at their rates, not whatever the doctor charges.

Word of advice - always ask how much consults are before going and ALWAYS ask for a quote before surgery! Also, it's impossible to put up a list of all tariffs for all medical aids - it would be about 10 pages per medical aid, and they're in code form.

If anybody wants the medical aid rate for a specific procedure, ask here and I'll see if I can give it.
Click to expand...

Um.....

http://healthman.co.za/Tariffs/PubTariffs2016

Not exhaustive, but the big ones are there, and the HealthMan private tariffs...
 
Dude, read my later post about it as well. Those are links - not a list of prices, which is what I understood. Also, they aren't nearly comprehensive enough and some of the big medical aids aren't even on there, let alone the smaller options.

I never said it wasn't possible to give a link like this - I get the Heatlhman email as well, but there are numerous procedures that aren't on that list.
 
He said younger members only join medical aid schemes when they are ready to start a family, which then means that they use more funds that what they contribute.

Broomberg said healthcare inflation was not to blame for high medical aid fees, but rather members who overused the services.
Click to expand...

/shakes head ......
 
People are missing the boat here.
The problem is PMBs, and Medical Schemes dogmatic interpretation and observance of these.
The PMB conditions have not been reviewed since 1998, so these hospital plans are almost 20 years out of date.
There is a competition commission enquiry happening as we speak, around this particular issue.

http://www.dailymaverick.co.za/article/2016-03-06-health-e-the-blame-game/#.Vt5_UMczzpE
http://www.iol.co.za/business/perso...medical-schemes-to-blame-for-all-ills-1993749
http://www.bdlive.co.za/national/he...ts-decision-a-boon-for-medical-scheme-members
http://www.bdlive.co.za/national/health/2016/02/17/medical-schemes-pick-and-choose-diseases-to-cover

PMBs are the problem, and PMBs need to change. Medical Schemes are defiant in this regard, and are therefore part of the problem. I love how a call-centre agent reads from a script and tells a specialist - with upwards of 2-3 degrees and 10 years of studying - what medication they can prescribe, and at what particular doses, for a particular condition. The literature changes, but Schemes do not, and this is not only unsustainable and untenable, but unethical too.
 
I've got a complaint with the MSA against Discovery for PMB. Refuse to pay for medication yet diagnosed by both doc and cardiologist as required, waiting resolution.
 
Kosmik said:
I've got a complaint with the MSA against Discovery for PMB. Refuse to pay for medication yet diagnosed by both doc and cardiologist as required, waiting resolution.
Click to expand...
Discovery is loathe to pay for anything even remotely related to PMBs.
 
Kosmik said:
They don't agree.
Click to expand...

They won't pay for PMB medications (out of hospital) unless that particular conditions forms part of one of the 25-CDL (chronic disease) conditions.

(Ludicrous, I know, according to the Medical Schemes Act there are only 25 chronic medical conditions requiring treatment, across the whole of medicine).

Otherwise, costs of medications will come out of your MSA - it's wrong on so many levels, and I hope the MSA is able to help you.
 
Went for my procedure at the GP, Disocvery rate is R800 for it, fortunately Intercare only charged me R600, I think made up of R550 + R50 (for consultation).

Next up seeing a specialist, and then booked in to hospital if the specialist wants to do some further tests on me.
 
bumbledore said:
PMBs are the problem, and PMBs need to change. Medical Schemes are defiant in this regard, and are therefore part of the problem. I love how a call-centre agent reads from a script and tells a specialist - with upwards of 2-3 degrees and 10 years of studying - what medication they can prescribe, and at what particular doses, for a particular condition. The literature changes, but Schemes do not, and this is not only unsustainable and untenable, but unethical too.
Click to expand...
I know someone who was told they could use the (outdated) cancer treatment dictated by Discovery or pay for the newer, and much more effective, treatment out of their own pocket. In other words choose between dying, probably dying and probably living, but going bankrupt.

AlphaJohn said:
Edit: One thing med-aid people dont do is go the extra step in trying to drop the cost. One example My opp is only for tomorrow afternoon, I was suppose to be booked in tonight and pay for 3 days. After 2 phone calls I am only going in tomorrow after 12 so I only need to pay for 2 days instead. Yes its only R3k less but it was worth the 2 calls.
Click to expand...
On the other hand I know someone who was on a hospital plan, left hospital two days early because the doctor said it would be fine to do the remainder of the recovery at home. Saved the medical aid thousands of Rands. Discovery turned around and refused to cover the R1000 worth of medication they took at home even though they would have to have covered that and the cost of the hospital bed if the person had remained in hospital. Then they wonder why their customers think they're scumbags. That same person will in future remain in hospital for the maximum time allowed. Everyone who hears their story will do the same.
 
bumbledore said:
They won't pay for PMB medications (out of hospital) unless that particular conditions forms part of one of the 25-CDL (chronic disease) conditions.

(Ludicrous, I know, according to the Medical Schemes Act there are only 25 chronic medical conditions requiring treatment, across the whole of medicine).

Otherwise, costs of medications will come out of your MSA - it's wrong on so many levels, and I hope the MSA is able to help you.
Click to expand...

It actually is one of the 25 Chronics but they don't agree with the doctor and specialists assessments. And since it's controlled now that I pay for the medication out of my own pocket, the only way to get them on board is to actually stop and fall ill. Hence the complaint to the Medical Scheme Council\Association.
 
What utter bull****! The reasons he supplies apply to ALL medical aid providers, not just discovery, so it does not explain why DISCOVERY is expensive!!!
 
bumbledore said:
They won't pay for PMB medications (out of hospital) unless that particular conditions forms part of one of the 25-CDL (chronic disease) conditions.

(Ludicrous, I know, according to the Medical Schemes Act there are only 25 chronic medical conditions requiring treatment, across the whole of medicine).

Otherwise, costs of medications will come out of your MSA - it's wrong on so many levels, and I hope the MSA is able to help you.
Click to expand...

There are more PMBs than the 25 chronic conditions, see here: http://www.selfmed.co.za/pmb-treatment-pairs.aspx
 
You must log in or register to reply here.
Back
Top
Sign up to the MyBroadband newsletter
X