Prescribed Minimum Benefit

Hi

My wife has asthma, asthma is a Prescribed Minimum Benefit for all medical aids. As I understand it, a Prescribed Minimum Benefit claim has to be paid by the medical aid irrespective of the service provider, obviously within reason. I am on a Delta plan, Last year in September my wife had a severe asthma attack while we were visiting her mother in Welkom. Welkom has no Delta approved Hospital so I took her to the Discovery Key Care Hospital which was the closest to us at that moment.

If you do not know what an asthma attack is, the easiest way to describe it to you is as follows. Place a plastic bag over your head tie it nice and tight around your neck and now run around a medical aid office and try to get someone to help you. You need to breathe to live, if you can not breathe you can not live, asthma is a life-threatening condition.

In October I asked Discovery why the Hospital bill or at least part of it was not covered by the Prescribed Minimum Benefit. I was told the hospital did not do the paperwork correctly so I was to get documents from the hospital and from the doctor on duty to state that it was indeed an emergency. It took me 2 months and a lot of bad words but I got the requested paperwork. In December I forwarded it to Discovery. And now today I get an e-mail where they send me a form that needs to be compleated by the hospital and the Dockter. Could they not give me this form on the first day I made the inquiry. This is now costing me more in driving up and down from Johannesburg to Welkom and penalties and lawyer costs than what the hospital bill was. These people work with these things every day of there lives why is it so difficult to do a proper job?

I think this is pathetic service from Discovery and I must say the hospital accounts was not a lot of help either.

Regards

Pieter Coetzee