Surprise co- payment every month

There was an agreed-upon dental cost, and we had to pay R18,000 upfront for what the medical aid did not cover at the orthodontist. However, every month when my son goes for adjustments on his braces, the medical aid only covers a partial amount, and at times, I still have to pay up to R2,000 out of pocket.

I am unsure whether the orthodontist aligns with standard pricing or if the medical aid uses outdated pricing. As a client, I believe that both the medical aid and the orthodontist should prioritize their clients' interests. The total agreed-upon cost exceeds R40,000, which is a significant amount. Yet, it seems that neither party is making an effort to offer the best possible deal or adequately prepare the client for such a large financial commitment—especially after already paying R18,000 upfront, with additional contributions from the medical aid.

Why am I paying R18,000 per month for medical aid if I still have to cover these additional costs? It seems more logical to cancel my medical aid, invest that R18,000 in a savings account, and pay cash when needed. In today's economy, very few people have an extra R2,000 readily available after already paying such high medical aid premiums.

Something about this situation does not seem right, and I need a valid explanation with measurable facts. If I do not receive a satisfactory response, I am prepared to escalate this matter further. Additionally, I would like to see a comparison of orthodontic pricing across different providers and understand why the medical aid does not offer alternatives that align with best practices and optimal patient outcomes—without placing the entire financial burden on the client.

Why are we not given the option of pre-authorization to avoid these kinds of unexpected costs?