Do not take gap cover with Admed (Guardrisk Insurance)

I was recently hospitalised for a maxiofacial procedure and given the Discovery medical aid option I am on, the bill for the specialist surgeon was paid from my savings and the balance (I.e. shortfall) was claimed from Admed.

To my surprise, I was informed by Admed that (unfortunately) they will only pay for shortfalls where the medical aid scheme actually pays a portion of a claim.

I questioned this on the basis that my invoice was paid to the limit of my saving and the balance which was not payable as I had reached by limit was claimed from my gap cover considering the invoice was from a specialist surgeon.

This is extremely ********* as how can they now say that payments are code/medical aid payment dependent. The medical aid (to my knowledge) paid what was available in my savings and this was not based on procedure codes.

I would advise that anyone taking gap cover with Admed (Guardrisk Insurance) do not do so, as besides the non-payment of claims, the customer service in terms of feedback/responses is shocking, I as a Client have to contact them for feedback or explanations.