Be wary!! They pay very very little for claims in hospital regardless of pre approvals

Be incredibly cautious when signing up with this medical aid. They will pay little to nothing for claims. They are wonderful at drawing their premiums on time every month. And they are happy to pay for everything from your day to day cover because its yechincally your money. But for large procedures they will "kick you in the teeth". We have been with this medical aid for a little under 2 years now. We have paid in excess of R100 000 in premiums and are certainly not on one of the lowest plans. We had to have an emergency C-section to help our baby and were able to do a pre-approval to which we received a response that said they would cover the procedure with no exclusions or co-payments. That, to us, sounds wonderful and we go into the procedure confident and comfortable. At the end of the procedure, outside of the hospital bills we start receiving and paying Dr's bills which we then submit claims for, the procedure Dr's cost a little over R30 000 and that's without bloods and whatnot. We pay this "medical aid" R6408 a month. They paid us back for the procedure a little over R8700 in totality which means their "no exclusions or co-payments" actually means a lot of exclusions and copayments of 71% of the bill. This medical aid only covered 29% of the Dr's bills. The amount paid back isnt event the equivalent of 1 and half months premiums. We would have been better covered if we'd just put our money in the bank for 3 months. Not to mention they will not cover the private room which we had to take due to lack of availability of semi private rooms which are the only ones covered. Which means that we racked up a total of R41 000 in bills and the medical aid gave us back just shy of R9000. They come back at you with their tarrif amounts and whatnot. The thing that bothers me the most regarding this, is they are the ones that set the tarrif amounts, and there just arent any Dr's on this planet that would preform these procedures for the amounts they deem fitting. Of course if this were the case then all medical aids and all medical aid plans would cover the same amount as the tarrif would be a set figure, regradless of premium. However it is your premium the defines how much the "correct Dr's tarrif" is not the Dr's. They know these procedures do not, have not and never will cost R9000 in totality for the surgeon, the anesthesiologist, the nurses and the rooms, but unless you pay more well this R9000 is what it should cost. Just be incredibly cautious do youre research and probably go with another medical aid.