Discovery paying a mere R460 as a 100% rate for a anethetist

Dear Discovery, I have phoned your call centre as well as corresponded to you over email with no avail. So I am hoping someone with knowledge on your payment policies will read this and please kindly provide me with answers. I got pre-authorization on the 21st for a procedure that I need to get done on the 4th of December. I was supp**** with a pre-assessment form to see what I had to pay out of pocket. The hospital is not on my list, so I knew I had to pay a hospital fee, but just wanted to get an idea if there would be any other shortfalls regarding my anesthetist and doctor.

I received the pre-assessment back on the 27th of November, and to my shock learned that while the anesthetist fee is R9000, Discovery will pay a mere R460.00 of this amount – which amounts to 5,11% of the fee. On my pre-authorization document I read the following phrase ‘If you use a healthcare professional who the Scheme does not have an agreement with, we will pay claims according to your plan at up to 100% of the Scheme Rate. You have to pay the rest of the account.’ So my question is; do you pay ALL anesthetists that is contracted with Discovery R460.00? Is that 100% of the Scheme Rate for an anesthetists theater fee?

Because if I take my dog to the vet and he has to get anesthesia the cost is around R800. Are you telling me that you are paying a mere R460 for a human anesthetist that needs to keep me alive during my hospital procedure? Is it possible to provide me with an official document so I can see your ‘100% Scheme rates’ that you pay according to the codes I have provided? Thus far the call centre person told me that she doesn’t know what a ‘100% fee’ is for a anesthetist contracted by Discovery. When I asked to speak to someone who might know, she kept me on the line, and said she did ask and no one there knows.

After seeing this, I am also questioning the fact that only 25,77% of my doctors fees will be paid. It worries me that I have to go on a pre-assessment staff members calculations, which can’t even confirm that R460 is in fact the 100% scheme rate for an anesthetist. Your feedback will be greatly appreciated. In simple terms, without going in circles and bringing the 100% scheme rate up. I want to know what is the 100% scheme rate for the codes I provided and I would like to see this in official writing. Thank you