GapCover Fact or Fiction

I had to undergo a Quadruple Bypass operation in December 2019 and submitted my claim for GapCover with Insuremed. The claim was denied since the procedure is included in the list of 270 “Prescribed Minimum Benefits” as per the Medical Aid Schemes Act. I was horrified to see the list of procedures included in the list and as such, not covered by GapCover. Insuremed maintains that all the costs should be paid by my Medical Aid (Momentum Health) who in turn say that this was a “planned” procedure and I should have utilized Service Providers included in their list of Providers. Who in his right mind will plan such a massive intervention to take place 6 days before Christmas and with only 1 week available to “plan” after having been diagnosed with the blockages. Raises the question if there is any benefit in having GapCover.