Maternity cover is not transparent

I am posting this review to warn future members about Discovery Medical Aid’s lack of transparency, particularly when it comes to maternity and childbirth benefits.

Discovery advertises that it pays up to 200 percent of the Discovery Health Rate for maternity services. However, there is no published list of Discovery Health Rates. During a phone call with Discovery, reference number ***, I was told directly that no such list exists, which means members cannot know in advance what will actually be paid.

The only way to find out is for a doctor to submit billing codes and then wait to see what Discovery decides to cover. This makes it impossible to budget or make informed decisions for a major and planned medical event like childbirth.

In our case, the amount claimed for OBGYN services was R24,305.28. Discovery reimbursed R13,929.40, leaving us with R10,375.88 out of pocket.

What makes this particularly concerning is that Discovery would have paid the full amount if we had used a so called network OBGYN, even though OBGYNs generally charge the same rates regardless of network status. In both situations, the doctor is paid by the patient, not directly by Discovery, yet different reimbur*****t rules are app****.

Discovery based the benefit on a Discovery Health Rate of R4,739.00 for an OBGYN. No private OBGYN at a Mediclinic or similar hospital charges anything close to that amount. If the Discovery Health Rate does not reflect real world costs, then referencing it as a benefit limit without proper disclosure is misleading.

This effectively forces women to choose doctors based on network status rather than comfort, trust, or continuity of care. If you are considering Discovery Medical Aid and plan to have children, I strongly recommend questioning this upfront and getting clear written confirmation of what will actually be covered.