Maternity benefit/ lack thereof

I would like for someone to kindly explain a few things to me.

After numerous calls where we called to inquire about the maternity benefits and pregnancy procedures we were happy that we had found a Gynecologist "fully covered" on our plan.

Reference number ********** 306

After our 1st visit we noticed that the full 1st consultation of R1600 was deducted from our savings account and not the "maternity benefit"

Blood test of R1300 which would also normally be covered under "maternity benefit " also taken from savings

Reference number ********** 805 Reference number ********** 782

Upon following up on this issue and why it was deducted from our savings we were advised that "we had not activated our maternity benefit", even though we had called on 2 occasions, neither of your consultants had advised us we would need to make a separate call to specifically activate it. As if you were not aware what codes were being charged on the claim (full scan, urine and bloods)

we continued seeing doctor up until 24 weeks where we were informed we would not be able to delivery at the hospital without a co-payment of R7000 as the hospital was not on our network.

Once again we made the call to discovery to find a gynecologist within the network that is covered in full.

We were happy that we had once again found another doctor, we were advised upfront that we would need to pay the doctor and claim from the medical aid as per claims process - no problem

The claim came to R1200 - which we paid out of pocket, bearing in mind the doctor is listed as "fully covered", we also made a call to confirm that this would be paid from maternity benefit and not from our savings

Reference number ********** 030 Claim ref - Your reference number is ********** 079, submitted on the 5th June . Today we received feedback that we would receive refund of R878.90

Consult cost - R700 - your "maternity benefit" only pays R400 (for a doctor listed as fully covered)

the remaining 2 costs which your are not covering is the Doppler (scan) which is necessary and the whole point of going for checkups with your doctor during pregnancy.

Instead you are charging this completely out of our savings

A urine dipstick is also something you are not covering under your so called maternity benefit.

Once again a urine sample and scan are both things which are done on every visit. ====================================

So in total of things that should have been covered by your "Maternity benefit" you have taken a R2900 within the 1st month and your excuse was that we as clients did not specify we wanted maternity benefit activated even though we called your centre on 2 occasions inquiring and asking assistance.

And then a further R461 out of a bill of R1200 you are refunding me out of my savings because you do not cover (doppeler/scan) and a urine dispstick, I repeat this is a doctor listed as fully covered on your network. Besides us having the "Maternity benefit"

You have left us as 1st time parents with a very poor impression of your company and have caused us no joy on this journey. You appear to hide behind fine print and technicalities as to why you should not pay. We did all we could, calling and asking assistance, your staff were unwilling to provide us with doctor codes or practice numbers and these are within your own network. We were instead advised to go to the hospitals and get it ourselves.

You have made the whole process unnecessarily stressful and in no way have you tried to make this process easier.

Please advise how you can help to make this Maternity Benefit and actual benefit because thus far it has been nothing but a headache.

Regards, Member ********** 50