What is meant by In-Hospital??

Good day to everyone.

I am writing this today to share my experience of TopMed Medical Aid – option Active Saver. As an adult and parent you read that you are 100% covered within hospital. You see yourself as a young active family so the plan made sense.

Now, we know that the plan has no dental benefits, and we also fully understand the total lack of sympathy and empathy of what that means.

Today we realised that my two(2) year old son’s pre-admission was denied. The reason that was given is that we have no dental benefits. This is not something that you plan for you two year old.

As a reasonable man I told the company that yes, I understand that I have no benefits. I am willing to pay both doctors. I will pay the Dentist and I will have to pay the Anaesthesiologist. So in my mind the “in-hospital” part will be covered right! No – it is not!

This is not a procedure that can be done at the back of a barber shop! I was then told that the payment will be coming from my “Active Savings” which basically would drain out my full years of benefits in an instant. This will then leaving three adults, and 2 children starting the winter months with absolutely no savings account.

So in summary I have to pay the Dentist the Anaesthesiologist and the Centurion Day Hospital for everything.

Here is the final back break – because they declined my “In-Hospital” procedure my GAP cover does not kick in as the say “they only pay for the shortfall for what was authorized”. Very poor communication from the company – only on the info feed on the app which is very difficult to read. I had to phone in to be told that we were declined.

Stay away from this option if you consider yourself a young family – children will have problems with their teeth and it is not always going to be do-able within the chair. Was totally let down when we desperately needed them the most.

I will be cancelling my policy as Medihelp, Bonitas ..etc all have this as a standard for all children below 7.