Medical Insurance *******

In July 2025, I had to have an emergency spinal fusion after an accident. I contacted Kaelo Health, my insurer ( through Dischem) and received authorisation with a total of 1.5 million rand allocated for the procedure. The hospital account was settled for R343,000.00, with a small copayment required from me. Other service providers were also paid, but as far as I can ascertain not more than R500,000.00 was settled. When it the the neurosurgeon and anaesthetist's accounts, suddenly the insurance claims the funds are depleted and start citing tariff limits. The anaesthetist's account was for some R40,000 and Kaelo only paid R2950.00! This for a 5 hour operation; Kaelo also paid the neurosurgeon inly R39,000.00 out of a total of R300,000.00. The insurer refuses to communicate verbally and only replies to emails stating charges in excess of their tariffs. When they allocated R1.5 million rand for the procedure I was told I woul not be liable for any outstanding amounts and the entire procedure wold be covered. There was no mention of tarriff limits