1 reviews | Active since Oct 2015
Claim received - disgrace!
My wife went in for a C-section birth. There were no complications and everything went well. Discovery has a 100% rate for this code of R3500 +-. This R3500 is supposed to cover the Doctor delivering the baby and his assistant. We are on the essential saver with Discovery.<br> <br> I find the payout of R3500 +- very low and actually misleading to the public when they say they cover 100% of THEIR rate. They refused to give us THEIR rate value in Rands prior to the operation saying only that they cover 100% of their rate. In hind-site this knowledge would have forced us to choose one of their doctors. I also find this practice very much against the consumers choice. We either need to choose the Discovery affiliated Doctor or go to our own and pay ourselves - what is the health plan for?
Please allow me to provide some background on how we fund your in-hospital claims on your chosen plan type. I note that you are on an Essential Saver plan which covers you at 100% of the Scheme rate in-hospital. This means that if you make use of a provider who is not a Designated Service Provider (DSP), you may experience a shortfall. The Scheme offers member a tool called Medical and Provider Search (MaPS) tool on the website to afford members an opportunity to make use of providers to avoid shortfalls. The Scheme rate is determined to ensure long-term sustainability as you would understand that as a funder it would not be possible to fund all costs irrespective of what providers may charge. For this reason we set a fair Scheme rate for each procedure to help with keep the Scheme sustainable.
We also have an additional process where members can obtain a pre-assessment prior to a procedure to plan for any shortfalls. This is usually done by completing a form with the estimate from the treating doctors, we would then provide you with an estimate of cover according to your plan.
I'm sorry that I could not provide a different outcome.
Regards
Rishana
Please allow me to provide some background on how we fund your in-hospital claims on your chosen plan type. I note that you are on an Essential Saver plan which covers you at 100% of the Scheme rate in-hospital. This means that if you make use of a provider who is not a Designated Service Provider (DSP), you may experience a shortfall. The Scheme offers member a tool called Medical and Provider Search (MaPS) tool on the website to afford members an opportunity to make use of providers to avoid shortfalls. The Scheme rate is determined to ensure long-term sustainability as you would understand that as a funder it would not be possible to fund all costs irrespective of what providers may charge. For this reason we set a fair Scheme rate for each procedure to help with keep the Scheme sustainable.
We also have an additional process where members can obtain a pre-assessment prior to a procedure to plan for any shortfalls. This is usually done by completing a form with the estimate from the treating doctors, we would then provide you with an estimate of cover according to your plan.
I'm sorry that I could not provide a different outcome.
Regards
Rishana