*********: Don't honour claims & don't tell the truth about their cover

When we found out we were expecting a baby we checked out the benefits our Discovery medical aid apparently cover. It said it covered the pregnancy blood test, 2x ultrasounds & 8x gynaecologist consultations.

My wife had the initial blood test, ultrasound, intitial consultation & further blood tests. All my claims, totalling over R4000, were rejected. Apparently cover is only activated once you register your pregnancy, even the blood test to determine whether you are actual pregnant! This stipulation is at the bottom of their webpage of benefits, after pages of scrolling. The GP, receptionist at the gynaecologists, the gynaecologist or people at the blood clinics mentioned this. My GP said he didn't know when we asked him later. Surely Discovery should be informing medical practioners of this so they can tell members so they don't get caught out.

Not only are Discovery not fulfilling our claims because of a technicality, their cover isn't actually cover. They only pay our their Discovery medical aid rates for gynaecologist consultations & ultrasounds which is between 20 - 25% of the actual cost. Where do they get this rates from as no one charges that little? "Cover" implies full coverage. There in no mention of only partial coverage or coverage of up to their rates in the list of benefits. So basically Discovery are misleading people which is ********* & surely *******?

I spoke to a colleague & he said that he previously registered their pregnancy at about 20 weeks & Discovery paid out their claims. Discovery must have changed things recently so they can reject otherwise legitimate claims & make more profit. It is clear that Discovery don't actually care about their members. Having to activate cover is ridiculous & they do their best to hide this stipulation. If they cared then they would honour claims made before the registering the pregnancy, even if it was only for claims made a set period before the registration, or better still not have this rule!

We've spent over R150k for medical aid in the last 3 years & have had very little benefit from it. It's stressful enough having a baby & now we have to stress about having to pay for things because our medical aid isn't covering the costs it's supposed to. We would be much better off not paying for medical aid & just paying our for medical expenses as they come. It's pretty much what we have to do anyway!

I have emailed asking for more details about the plan & cover, because the website doesn't offer adequate information. I received an email saying that a specialist would get back in 2 business days. It's been almost 2 weeks now & no one has contacted me. I also filled out a complaint form & I have also had no response.

Thanks for nothing Discovery!