Misleading Co-Payment Terminology and Claim Processing

Dear Sasolmed/Discovery Team,

I am writing to formally raise a concern regarding a recent dental claim quote processed under my medical aid plan. The statement accompanying the claim indicates that the procedure was:

"Covered up to 100% of the lower cost of the scheme tariff, with a 20% deductible co-payment."

While I understand that some providers may charge above the scheme tariff, and that such differences may result in member liability, I am confused by the application of a 20% co-payment on a claim that is supposedly covered 100% by the scheme.

This wording appears contradictory. If the scheme covers 100% of the tariff, then a 20% co-payment effectively reduces the coverage to 80%, which is misleading. I would appreciate clarification on the following points:

What exactly is meant by “100% of the lower cost of the scheme tariff”? Why is a 20% co-payment app**** if the claim is covered at 100%? Is this co-payment standard across all dental procedures, or specific to certain providers or treatments?

Furthermore, I want to express my dissatisfaction with the lack of transparency and clarity in your terminology. I previously raised concerns about a R3,500 co-payment for my daughter’s wisdom teeth procedure at the hospital. No one could explain the basis for this charge, and it was only deferred after I escalated the issue. This experience has left me feeling that members are being bul**** into accepting misleading terminology, which does not reflect the true financial implications of the cover.

I will be questioning this kind of terminology every time it appears, and I strongly urge Sasolmed/Discovery to review and correct the language used in member communications and claim statements to ensure it accurately reflects the actual coverage and liabilities.