Scheme Rates Must Fall

I am at a point where I need to get rid of the villian that is Discovery. I have doctor's bills piling up because discovery only paid "up to the scheme rate". This scheme rate seems to have been put in place many moons ago and remained stagnant while the doctors increase their fees annually.

I recently visited a Paediatric Pulmonolgist who charges R1800 for 1st consultation and R1400 for a follow-up consultation. The 1st amount I claimed back from Discovery I only received R600 of the R1800. I called in today to ask for a list of all the Paediatric Pulmonologists in my area that Discovery have an agreed with on that scheme rate but the nearest doctor i was referred to is about 20 KM away from me. I called the doctor's office and I was told she does not use medical aid and her rate is R2000. I called again and I was referred to another doctor who was about 15KM away from me and the receptionist told me the doctor only works with kids from the age of 12, this is after I told the agent that my son is only a year old. The receptionist told me there is a doctor at a Netcare about 10KM away from me that is great with kids. I called that doctor and I was told she works on cash basis too and her consultation is R1400.

On both my phone calls, I asked for a list of all their doctors that they sat with and agreed upon that rate with so that I can identify those near me so that I start using those doctors and they could not provide it to me.

A Pulmonologist is a specialist, not a GP so I cannot believe that there really is a Pulmonologist in South Africa that charges R600 for a consultation. Maybe in the 3rd world provinces like Limpopo where Paediatricians charge R550 for a consultation as opposed to the starting amount of R1200 for a consultation in Gauteng.

Someone needs to revise these day light ******* scheme rates that Discovery is using to cheat their members and rob them of their money that they deduct monthly. If I live in Midrand, you cannot expect me to drive all the way to Sandton or Pretoria to consult at a doctor that Discovery approves of, the fuel and wear and tear expense to drive out there plus the consultation fee amounts to the consultation fee that I am avoiding at a doctor nearby who does not accept medical aid and charges an arm and a leg!!

To see one at Steve Biko means a waiting list of up to 6 months. I've been to a normal paeditrician and a GP but all they could tell me was it is a chest infection or a cough and I get prescriptions for antibiotics and cough suppressors. Only to find that my son needed to be put on Asthma treatment after visiting a Pulmonologist!!!