Reimbur*****t Rip-off

<p>For the life of me I still do not know why I am still using this medical aid and paying close to R3000 a month for nonsense. I am on the classic priority plan. The reason I chose this plan is so that I can have the freedom to choose whichever doctor/specialist I feel like seeing. I in turn receive a mediocre medical savings account to pay for me day to day medical expenses.</p> <p>My gynaecologist for a while now is in private practice. I chose her because I am comfortable with her as my doctor. She knows my medical history and she is in close proximity to where I live. Not that I need to explain myself; I am on the plan that I am so that I DON’T HAVE TO EXPLAIN MY CHOICE OF A DOCTOR!!!!! Discovery obviously does not see it this way…</p> <p>I paid for a consultation with my Gynae and in turn submitted a claim for reimbur*****t. The claim amounted to R1140, Discovery reimbursed me a ridiculous R371.30. I have almost R7000 in Medical Savings!!!!!</p> <p>Discovery’s ridiculous explanation of not settling the full amount is that my “doctor does not have a payment agreement with them. She does not charge Discovery rates. So I was only reimbursed the discovery rate”.</p> <p>I would like Discovery to humour me by answering the following questions:</p> <p>1. Which decent Gynae in private practice charges R371.30 for a consultation of any kind?!</p> <p>2. Which Gynae with a practice in the northern parts of Johannesburg charges R371.30 for a consultation?!</p> <p>3. Which Gynae with a practice within a private hospital charges R371.30 for a ****** consultation?!</p> <p>4. Which Gynae in private practice charges R371.30 for a 5th month pregnancy consultation inclusive of ultrasound etc.…? do humour me please!!!!!</p> <p>I have been using this particular Gynae for a while, even before pregnancy. For as long as I have being seeing her, she has NEVER been affiliated to ANY medical aid. I have ALWAYS paid out of pocket for the consultation (which has NEVER been less than R1000), and in all instances, Discovery reimbursed me in FULL! FYI, I have ALWAYS been on the same plan.</p> <p>Further questions to Discovery:</p> <p>1. Why were my previous claims for the same doctor always reimbursed in full from my MSA even though she has NEVER charged Discovery rates?</p> <p>2. How exactly do you work out the rate for a consultation with Gynae to amount to R371.30 considering that the majority of Gynae’s in private practice charge in excess of R1000 for a mere consultation. This excludes testing of any blood work or samples taken! Not to mention a pregnancy consult that includes ultrasound scan!</p> <p>3. People take out medical cover so they can freely consult with doctors and specialists in private practice. Your rates should obviously be linked to the aggregate rates in private practice for that specific medical field. They obviously aren’t. Are you rates thumb-sucked as a suspect or intentional done to exploit us? My MSA is MINE, NOT Discovery’s! Why then should you dictate to me where and how to use it?!</p> <p>I would expect to pay R371.30 for a consultation at a public clinic or for a doctor in the rural areas, not one in private care!</p> <p>4. I am not on a Key Care Plan. Explain to me why my choice of a doctor (My plan is supposed to allow me the freedom to choose) is now all of a sudden not acceptable by Discovery? I am not on Key Care or one of your lower priced plans were members are enforced to use your doctor in your “Network”.</p> <p> </p> <p>Perhaps the reason most Gynae’s and other specialist medical providers no longer affiliate to medical aid is because your rates are ridiculous and not feasible. If the R371.30 is what you would have paid my Gynae if she was affiliated to yourselves, I understand why she would distance her practice from medical aids. It is a joke!</p>