Failure to cover shortfall

<p> </p> <p>My daughter ran into the corner of a door I'm September this year. You can imagine the horror of finding her lying on the floor screaming, with blood everywhere. When I picked her up and saw the deep gash on her forehead I too began screaming. We rushed her to St Augustine's hospital in Berea and had to wait one hour to be called into a room for examination. We then waited 2 hours for a doctor to see her and for her to get pain medication. We were told that she had to go into theatre and waited another 2 hours for this.</p> <p>This is everything that happened on the day of my daughters accident.<br />We got an email from medical aid not long after that stating that they will pay hospital bill, but will only pay R3000 to the surgeon from a R12000 bill, and R2000 to the anesthetist from a R7000 bill. The doctors had charged way above medical aid rates. They had asked if we had gap cover so that they could send us a fat bill. This was no problem as we did have gap cover. We were covered for 500% above medical aid rates.</p> <p>However, after submitting all the claims to gap cover we were told that the claim was rejected because it was a pmb (prescribed minimum benefit) and that our medical aidmust pay. We were absolutely shocked. We thought we were fully covered with both a medical aid and gap cover. We now have to fight with these two companies to pay these doctors bills. They both take your money very nicely every month but when it comes time to pay they look for every reason not to.</p>