Anything not to pay

So I tore my Hamstring and needed to see a specialist. I went to the network doctor as prescribed to gain a referral to a sport physician specialist in Rosebank. I had phoned Camaf to ensure the correct procedures regarding this and I was told that all I need is a referral letter and I'm covered. It was also mentioned that there is no list for specialists on network, thus I can freely choose the specialist at my will.

So I was referred by the network doctor to the specialist and attended 3 sessions of treatments for my leg. Each session was paid out my pocket and I did so because I thought that the medical aid would cover me. I mean specialists are expensive and they do take a large portion of your budget.

Well when I got response from Camaf I was shocked to find out that they're only covering 17% of the bill. The reasons they gave me were something magical:

1. They considered the specialist to be a GP, as his practice number says he's just a GP. Ok, so when I asked about a list of specialists, there isn't one? So I must know that this is the case? It's actually a laughable matter as this just turns to be a guessing game of who's a specialist and who isn't, with the end result of you losing. So Camaf decided to pay R270 of a R850 consult, 80% of the medical aid rate for a GP as it wasn't in Network. I was referred which allows to see any specialist as stated? Also must I request the practice number beforehand and check with you guys if I'm 100% covered, because that's how professional medical aids work right? I clearly missed the memo regarding specialists and medical administrative issues.

2. The injections I had was R550 a pop, I had 3. Camaf covered 2 for R94 each... Yes R94 saying that's the medical aid rate for a blood test technically. They failed to understand that this isn't a normal injection as they reckon, but a plasma injection, hence the larger than life injection price. They rejected the last one saying that there is no ICD code, yet the description is the same as the others?

3. I then call them asking what's the case with all this, just to get a response that my query is unique and the consultant has never dealt with this. I know it's not the consultants fault for any of it, but I mean find solutions except telling me how fair this is.

4. The cream of the crop: I submitted a statement, detailing all of the balances and payments I made. What does Camaf do? They're going to pay the supplier i.e. the specialist with the 17% of the bill. The balance is 0 on the statement. I need to get refunded my dismal amount, not the specialist who has taken his sum of money , never to be reimbursed.

I have to admit that for a "professional" medical aid, I am actually shocked by how you will literally find any excuse to not pay, make unreasonable assumptions and just not live up to a professional standard. With that being said I will be taking my money to another medical aid, as your customer is just another number for you to capitalise on.