Basic Scheme Rates are Ridiculously Low
My Discovery premiums together with the additional amounts I pay where there is a shortfall which is common with the majority of my claims is actually 60% of my total monthly expenditure. What I find difficult to understand and accept is how, in the year 2023, the Discovery scheme rate for a specialist Neurosurgeon is only R682. Surely this is ludicrous. This is less than GPs charge or even a podiatrist. Perhaps the Neurosurgeon is a rip-off charging R2200 but it seems ridiculously low for the scheme rate to be as low as R682. Just a warning that the statements made when marketing Discovery Health products that they’ll pay up to 100% or even 200% of scheme rates are relatively worthless when the scheme rates are a mere fraction of what these specialists charge. It’s a sad indictment of the medical aid system in South Africa when you have to take out more Gap insurance to cover the gap between what your medical insurance will pay and what the industry specialists and surgeons actually charge. It feels like a double taxation. If you do not take this double insurance you could end up in financial ruin where you to require extensive medical treatment or surgery only to find yourself owing hundreds of thousands of Rand which is the gap between the actual cost and what your medical insurance will pay.
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Replies (6)0
Replies (6)'s updateReviewer Update
19 Oct 2023, 08:38Another example. My wife had a procedure in hospital. The gastroenterologist charged us R11600. Discovery paid R4300 leaving a “gap” of R7300 out of our own pockets. And this was a minor procedure. So beware - major surgery could leave you with unmanageable debt.
's update19 Oct 2023, 08:38
Reviewer Update
Another example. My wife had a procedure in hospital. The gastroenterologist charged us R11600. Discovery paid R4300 leaving a “gap” of R7300 out of our own pockets. And this was a minor procedure. So beware - major surgery could leave you with unmanageable debt.
Discovery Health's replyOfficial
19 Oct 2023, 10:26Dear Alun A
We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible.
Regards Discovery Health Servicing Team
We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible.
Regards Discovery Health Servicing Team
Discovery Health's reply19 Oct 2023, 10:26
Official
Dear Alun A
We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible.
Regards Discovery Health Servicing Team
We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible.
Regards Discovery Health Servicing Team
Discovery Health's replyOfficial
23 Oct 2023, 06:49Dear Alun A
We’ve responded to your query.
Regards Discovery Health Servicing Team
We’ve responded to your query.
Regards Discovery Health Servicing Team
Discovery Health's reply23 Oct 2023, 06:49
Official
Dear Alun A
We’ve responded to your query.
Regards Discovery Health Servicing Team
We’ve responded to your query.
Regards Discovery Health Servicing Team
's updateReviewer Update
23 Oct 2023, 09:46Dear Discovery Health,
Please note it was a statement NOT a query. Your response was as insulting, meaningless and disingenuous as you could get. You cannot respond appropriately because your position is inexcusable.
In future I suggest you do not send me brief insulting letters from an arbitrary individual with whom I cannot communicate especially when I was making a statement and asking you absolutely nothing.
Your “scheme rates” are ridiculously low. They’re a joke - even 20 years ago your current rate for a neurosurgeon would’ve been extremely low.
So, in future, do not insult me with a brief letter explaining what I already know and in no way whatsoever justifies your “scheme rates”.
Please note it was a statement NOT a query. Your response was as insulting, meaningless and disingenuous as you could get. You cannot respond appropriately because your position is inexcusable.
In future I suggest you do not send me brief insulting letters from an arbitrary individual with whom I cannot communicate especially when I was making a statement and asking you absolutely nothing.
Your “scheme rates” are ridiculously low. They’re a joke - even 20 years ago your current rate for a neurosurgeon would’ve been extremely low.
So, in future, do not insult me with a brief letter explaining what I already know and in no way whatsoever justifies your “scheme rates”.
's update23 Oct 2023, 09:46
Reviewer Update
Dear Discovery Health,
Please note it was a statement NOT a query. Your response was as insulting, meaningless and disingenuous as you could get. You cannot respond appropriately because your position is inexcusable.
In future I suggest you do not send me brief insulting letters from an arbitrary individual with whom I cannot communicate especially when I was making a statement and asking you absolutely nothing.
Your “scheme rates” are ridiculously low. They’re a joke - even 20 years ago your current rate for a neurosurgeon would’ve been extremely low.
So, in future, do not insult me with a brief letter explaining what I already know and in no way whatsoever justifies your “scheme rates”.
Please note it was a statement NOT a query. Your response was as insulting, meaningless and disingenuous as you could get. You cannot respond appropriately because your position is inexcusable.
In future I suggest you do not send me brief insulting letters from an arbitrary individual with whom I cannot communicate especially when I was making a statement and asking you absolutely nothing.
Your “scheme rates” are ridiculously low. They’re a joke - even 20 years ago your current rate for a neurosurgeon would’ve been extremely low.
So, in future, do not insult me with a brief letter explaining what I already know and in no way whatsoever justifies your “scheme rates”.
Discovery Health's replyOfficial
30 Oct 2023, 09:21Dear Alun A
We’ve responded to your statement.
Regards Discovery Health Servicing Team
We’ve responded to your statement.
Regards Discovery Health Servicing Team
Discovery Health's reply30 Oct 2023, 09:21
Official
Dear Alun A
We’ve responded to your statement.
Regards Discovery Health Servicing Team
We’ve responded to your statement.
Regards Discovery Health Servicing Team
's updateReviewer Update
30 Oct 2023, 10:54To anyone interested in Discovery “Scheme rates” the following is a cut and paste of their response. So a warning to be very careful of how you read the “200% of scheme rates” and “100% of scheme rates” as it will never be close to what you might expect. These rates are reached through a highly complex set of actuarial algorithms which they have tried to describe in plain English. I cannot find this sort of explanation in the marketing material - perhaps I haven’t looked hard enough. Just be extremely careful how you interpret the benefits as described in the multiple different schemes they offer. And take Gap cover or you could end with a catastrophic financial problem. Also be aware that the closest scheme medical specialist contracted to Discovery could be 50km or more away from where you live.
“The Discovery Health Rate is the amount of money we believe is reasonable to pay from your available benefits, like the Medical Savings Account or the Hospital Benefit, for a specific healthcare service. This may be a doctor’s consultation, treatment or procedure. We set this rate every year, with a balance between protecting our members’ best interests, maintaining the Discovery Health Medical Scheme and the interests of other groups, like healthcare professionals. We also carefully balance the needs of our individual clients with those of all our clients as a whole.
We base this rate on our past claims experience, the estimated cost of covering all our members’ claims for that procedure in future, input from the healthcare profession and industry benchmarks.
Our decisions are not based on what we think providers should charge for their services, but on what the Discovery Health Medical Scheme can afford to pay for those services, while maintaining members’ benefits in the long term and keeping contributions reasonable. If they want to, members can still make use of the services of providers who charge more than the Discovery Health Rate. Members can choose to fund the difference in rates themselves.“
“The Discovery Health Rate is the amount of money we believe is reasonable to pay from your available benefits, like the Medical Savings Account or the Hospital Benefit, for a specific healthcare service. This may be a doctor’s consultation, treatment or procedure. We set this rate every year, with a balance between protecting our members’ best interests, maintaining the Discovery Health Medical Scheme and the interests of other groups, like healthcare professionals. We also carefully balance the needs of our individual clients with those of all our clients as a whole.
We base this rate on our past claims experience, the estimated cost of covering all our members’ claims for that procedure in future, input from the healthcare profession and industry benchmarks.
Our decisions are not based on what we think providers should charge for their services, but on what the Discovery Health Medical Scheme can afford to pay for those services, while maintaining members’ benefits in the long term and keeping contributions reasonable. If they want to, members can still make use of the services of providers who charge more than the Discovery Health Rate. Members can choose to fund the difference in rates themselves.“
's update30 Oct 2023, 10:54
Reviewer Update
To anyone interested in Discovery “Scheme rates” the following is a cut and paste of their response. So a warning to be very careful of how you read the “200% of scheme rates” and “100% of scheme rates” as it will never be close to what you might expect. These rates are reached through a highly complex set of actuarial algorithms which they have tried to describe in plain English. I cannot find this sort of explanation in the marketing material - perhaps I haven’t looked hard enough. Just be extremely careful how you interpret the benefits as described in the multiple different schemes they offer. And take Gap cover or you could end with a catastrophic financial problem. Also be aware that the closest scheme medical specialist contracted to Discovery could be 50km or more away from where you live.
“The Discovery Health Rate is the amount of money we believe is reasonable to pay from your available benefits, like the Medical Savings Account or the Hospital Benefit, for a specific healthcare service. This may be a doctor’s consultation, treatment or procedure. We set this rate every year, with a balance between protecting our members’ best interests, maintaining the Discovery Health Medical Scheme and the interests of other groups, like healthcare professionals. We also carefully balance the needs of our individual clients with those of all our clients as a whole.
We base this rate on our past claims experience, the estimated cost of covering all our members’ claims for that procedure in future, input from the healthcare profession and industry benchmarks.
Our decisions are not based on what we think providers should charge for their services, but on what the Discovery Health Medical Scheme can afford to pay for those services, while maintaining members’ benefits in the long term and keeping contributions reasonable. If they want to, members can still make use of the services of providers who charge more than the Discovery Health Rate. Members can choose to fund the difference in rates themselves.“
“The Discovery Health Rate is the amount of money we believe is reasonable to pay from your available benefits, like the Medical Savings Account or the Hospital Benefit, for a specific healthcare service. This may be a doctor’s consultation, treatment or procedure. We set this rate every year, with a balance between protecting our members’ best interests, maintaining the Discovery Health Medical Scheme and the interests of other groups, like healthcare professionals. We also carefully balance the needs of our individual clients with those of all our clients as a whole.
We base this rate on our past claims experience, the estimated cost of covering all our members’ claims for that procedure in future, input from the healthcare profession and industry benchmarks.
Our decisions are not based on what we think providers should charge for their services, but on what the Discovery Health Medical Scheme can afford to pay for those services, while maintaining members’ benefits in the long term and keeping contributions reasonable. If they want to, members can still make use of the services of providers who charge more than the Discovery Health Rate. Members can choose to fund the difference in rates themselves.“