Dischem Health MyHealth Medical insurance

I took this policy because one I am unemployed and therefore I definitely do not afford a traditional medical aid. I live with a chronic condition that requires me to get chronic medication monthly and requires me to see a specialist to manage my condition. When I initially took the insurance it used to allow me 2 specialist visits in a year, which worked perfectly for me as I see the rheumatologist twice a year. Last year I was informed that the policy has changed, I now get 1 visit in a year, which was not the initial agreement that actually led me to choose Dischem health. I had to accept that and had to make a plan to fully cover my second visit myself.

Fast forward now to March 2026, as per the knowledge I have, I am under the impression that I now have 1 specialist visit a year, okay I’ve made peace with that. I am off the impression that my one specialist benefit has a benefit amount of R2000. I have my appointment on the 13th of March, I called prior to obtain an authorisation, I go for my consultation, it amounts to R1300. I then submit my invoice along with the necessary documentations for the R1300 to be refunded to me, considering I have a benefit of R2000. To my surprise they had initially rejected my claim, stating that ICD-10 code was omitted or invalid, I had to query that and they corrected it and stated that my refund will be processed.

My refund is then processed but to my surprise, I am only refunded R812 and not the full amount of R1300. So I am trying to understand that if my benefit is at R2000 and I submit a claim of R1300 how is it that I am only refunded R812 and not the R1300?

I followed the very same process I did in March 2025, my consultation then was R1250 at the same doctor and I was refunded R1250 in full. Now March 2026, same process, same doctor but now different outcome.

I am truly struggling to understand what is happening, I am not receiving feedback. Has my benefit changed again? I don’t know. If that’s the case then the policy is no longer helping me at all. The reasons why I joined is no longer beneficial to me.

I went for blood tests too, they too were rejected. I honestly don’t know. I am not happy at all