TB
Taryn B
1 reviews | Active since Feb 2010
15 Sept 2021, 05:46
Not a Breast Cancer friendly gap cover!!!
Warning to those looking for a gap cover ⚠️ They do not cover up to 700% of the specialist's rate after medical aid pays their share. They cap the shortfall for reconstructive surgery after mastectomy due to breast cancer at R20,000 which leaves a massive shortfall to pay. With breast cancer being one of the most common female cancers (1 out of 7 women will be diagnosed at some point in their lives and from young to old) this gap cover is not a good option at all. This, I unfortunately only discovered after the fact. This creates an unnecessary amount of added stress after an already traumatic diagnosis and operation. There are many other gap cover options that coveres reconstructive surgery shortfall. 🎀
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Replies (7)
Total Risk Administrators's replyOfficial
15 Sept 2021, 12:32Good Day
We do cover up to 700% medical aid rates where your medical aid does not cover the full account. Breast reconstructive surgery has a monetary value of R20 000.00 and are not subject to 700%. Unfortunately we do not grant ex-gratia but I would suggest that you contact your medical aid as they would have an assistance program available to assist their members with huge medical expenses. TRA Management
We do cover up to 700% medical aid rates where your medical aid does not cover the full account. Breast reconstructive surgery has a monetary value of R20 000.00 and are not subject to 700%. Unfortunately we do not grant ex-gratia but I would suggest that you contact your medical aid as they would have an assistance program available to assist their members with huge medical expenses. TRA Management
Total Risk Administrators's reply15 Sept 2021, 12:32
Official
Good Day
We do cover up to 700% medical aid rates where your medical aid does not cover the full account. Breast reconstructive surgery has a monetary value of R20 000.00 and are not subject to 700%. Unfortunately we do not grant ex-gratia but I would suggest that you contact your medical aid as they would have an assistance program available to assist their members with huge medical expenses. TRA Management
We do cover up to 700% medical aid rates where your medical aid does not cover the full account. Breast reconstructive surgery has a monetary value of R20 000.00 and are not subject to 700%. Unfortunately we do not grant ex-gratia but I would suggest that you contact your medical aid as they would have an assistance program available to assist their members with huge medical expenses. TRA Management
TB
Taryn B's updateReviewer Update
15 Sept 2021, 13:37Breast reconstruction helps to restore both physical and emotional balance after the surgical treatment of breast cancer. There are many other gap cover options out there that offer a much better cover. According to both the hospital and the financial department at the surgeon, this is the first gap cover they have come across with such limited cover. To the consumer that is doing their research on gap cover, as per TRA management's statement above, they DO NOT cover upt to 700% of medical rates on breast reconstruction and I'm certain there are other limitations. Breast reconstruction can cost up to R120,000 as it is not like your normal cosmetic surgery, it is a lot more intensive. They advertise that they cover up to 700% but that means anything from 0 to 700%. Don't get caught unexpectedly like we did. It's enough to have to deal with a disease and then learn this information.
TB
Taryn B's update15 Sept 2021, 13:37
Reviewer Update
Breast reconstruction helps to restore both physical and emotional balance after the surgical treatment of breast cancer. There are many other gap cover options out there that offer a much better cover. According to both the hospital and the financial department at the surgeon, this is the first gap cover they have come across with such limited cover. To the consumer that is doing their research on gap cover, as per TRA management's statement above, they DO NOT cover upt to 700% of medical rates on breast reconstruction and I'm certain there are other limitations. Breast reconstruction can cost up to R120,000 as it is not like your normal cosmetic surgery, it is a lot more intensive. They advertise that they cover up to 700% but that means anything from 0 to 700%. Don't get caught unexpectedly like we did. It's enough to have to deal with a disease and then learn this information.
Total Risk Administrators's replyOfficial
15 Sept 2021, 14:46Good Day
If you make use of the Designated Service Provider (DSP) network of your medical aid, there should not be any shortfalls and the account would be covered in full by your medical aid. All Gap Covers have different benefits with a monetary value as these claims falls outside of the rules of your medical aid where you have to make use of a set of certain Service Providers. If you do not use the DSP Doctors as per the rules of your medical scheme there will be a shortfall that would normally not be covered by Gap Cover as you broke the rules of your medical aid. The R20 000 that was allocated for breast reconstruction is to assist members that made use of Doctors that are not on their medical aid DSP list. You are welcome to email us as to reason why you went outside your network and we will discuss this further in our Complaints Meeting. TRA Management
If you make use of the Designated Service Provider (DSP) network of your medical aid, there should not be any shortfalls and the account would be covered in full by your medical aid. All Gap Covers have different benefits with a monetary value as these claims falls outside of the rules of your medical aid where you have to make use of a set of certain Service Providers. If you do not use the DSP Doctors as per the rules of your medical scheme there will be a shortfall that would normally not be covered by Gap Cover as you broke the rules of your medical aid. The R20 000 that was allocated for breast reconstruction is to assist members that made use of Doctors that are not on their medical aid DSP list. You are welcome to email us as to reason why you went outside your network and we will discuss this further in our Complaints Meeting. TRA Management
Total Risk Administrators's reply15 Sept 2021, 14:46
Official
Good Day
If you make use of the Designated Service Provider (DSP) network of your medical aid, there should not be any shortfalls and the account would be covered in full by your medical aid. All Gap Covers have different benefits with a monetary value as these claims falls outside of the rules of your medical aid where you have to make use of a set of certain Service Providers. If you do not use the DSP Doctors as per the rules of your medical scheme there will be a shortfall that would normally not be covered by Gap Cover as you broke the rules of your medical aid. The R20 000 that was allocated for breast reconstruction is to assist members that made use of Doctors that are not on their medical aid DSP list. You are welcome to email us as to reason why you went outside your network and we will discuss this further in our Complaints Meeting. TRA Management
If you make use of the Designated Service Provider (DSP) network of your medical aid, there should not be any shortfalls and the account would be covered in full by your medical aid. All Gap Covers have different benefits with a monetary value as these claims falls outside of the rules of your medical aid where you have to make use of a set of certain Service Providers. If you do not use the DSP Doctors as per the rules of your medical scheme there will be a shortfall that would normally not be covered by Gap Cover as you broke the rules of your medical aid. The R20 000 that was allocated for breast reconstruction is to assist members that made use of Doctors that are not on their medical aid DSP list. You are welcome to email us as to reason why you went outside your network and we will discuss this further in our Complaints Meeting. TRA Management
TB
Taryn B's updateReviewer Update
15 Sept 2021, 15:21There is no DSP for this surgery in my area!
TB
Taryn B's update15 Sept 2021, 15:21
Reviewer Update
There is no DSP for this surgery in my area!
TB
Taryn B's updateReviewer Update
15 Sept 2021, 15:23For reconstructive surgery.
TB
Taryn B's update15 Sept 2021, 15:23
Reviewer Update
For reconstructive surgery.
TB
Taryn B's updateReviewer Update
16 Sept 2021, 09:30Dear TRA management, please supply me with your email address and name as per your last comment above.
TB
Taryn B's update16 Sept 2021, 09:30
Reviewer Update
Dear TRA management, please supply me with your email address and name as per your last comment above.
Total Risk Administrators's replyOfficial
17 Sept 2021, 07:50Good Day. You can email *** for attention Naomi. TRA Management
Total Risk Administrators's reply17 Sept 2021, 07:50
Official
Good Day. You can email *** for attention Naomi. TRA Management