Medical Aid without the Aid

I am keen to hear if any fellow members of Discovery Medical Aid has the same issue, and also to hear from Discovery on all their excuses on this.

Currently a member with an Essential Delta Saver plan. I understand the Medical Aid Savings, but of recent, it appears that EVERYTHING is coming off the so called MSA? After moving my husband onto my medical aid, I am left looking stupid and having to fork out my pocket for things now.

My balance of just under R13 000 was depleted in not even 1 month! Ok, yes, we both had eyes tested and got new glasses, was good to pay in on that as I know glasses appears to be more of a fashion statement instead of a medical concern.

This year has not been a great one, but looking at all the wonderful “benefits” we have, I was not concerned that we both fell ill in February. Dr ordered X-rays to be done, out the MSA. Medication prescribed, out the MSA. Then to my surprise, we only each have 2 Dr visits a year? Both on chronic, we need to see a Dr twice a year, which was also not taken out the chronic benefit, R600 cash paid. Try to claim? Forget it! That is a whole different saga! As a client, I should be well aware that the invoice should have nappi codes and this code and that code.

So now winter comes, I need to rush to emergency ward, received the claim notification, not paid due to no funds in MSA! So now I sit and wonder, what benefit am I getting? Let’s tally this up: 1. R 900 for triage admission 2. R 650 for the emergency dr 3. R 2 900 for blood tests 4. R 2 000 hospital bill

Then we have some more things to consider: 1. R11 000 for hospital admission (cause the hospital closest was not apart of their network) 2. R5 800 for medical aid monthly

So I want to figure the filling out: 1. If everything comes out of this MSA (which is 10% of your monthly contribution) why do you offer all these benefits? 2. My cover states all emergencies are fully covered, what is considered an emergency if a temperature of almost 39 degrees and body pains and black outs is not an emergency? 3. Do we as members really need to tell the ones we love to just hold being taken to hospital cause we need to make sure the hospital closest to us at this time is part of our network.

To me, and please let me know if you agree, what used to be medical aid has now become more administration and hard work if we need it. Healthcare to consumers with medical aid has become a game of Tetris as a consumer. Submitting a claim you get told to go to a retail store and ask for an invoice with relevant nappi codes, benefits is now added stress of running out of savings on your medical aid. Like I say, R13 000 depleted in less than a month? Then you receive a mail stating your chronic medication that is working for you is being removed from the list, so this tells me to be the test dummy to go take a different medication, cause Discovery decides to remove it from the list of medications on chronic.

Some of you might be saying “why you on medical aid then”, or “just move if you not happy”, well, being a client of discovery for over 10 years, the last few years have seen a change in the approach discovery has taken, from the clients are first, now it’s a case of “you don’t pay us now, we cancel everything” which is sad. In today’s world where things are not easy and we see an increase of the importance of our health, I would expect a complete different view from such a large corporation. In my opinion, our health and wellness is being managed and owned by medical aids! This is sad, as it feels like they are trying to play a role they have no right to play. I know many will give me backlash over this, but I have faith that many more will actually agree with me on this. What also will interest me is the response from Discovery, perhaps we get more than a “We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible.”