Thread: Discovery screwed me, they will screw you, get out while you can!

Yeah I am on the Coastal saver which has the MSA, doubt the Coastal Core has it. Only reason I am with Discovery, is the fact that its the Medical Aid my company is going with. Rather lucky I haven't had problems yet with them, touch wood. But I will be very certain that if I ever have to go to the hospital that I make sure they do it right.

Originally Posted by EyeGod

If I'd done this, then I'd have been covered for the Dec 2011 ER visit.

If you'd upgraded during the upgrade period in December 2011, it would only have taken effect from 1 January 2012, so wouldn't have been covered anyway. You would have had to upgrade in December 2010 to be covered for that.

Each plan is separate in Discovery. So ignore the investments, life insurance, etc. They mean nothing to medical aid issues. First thing I would do is read the medical aid plan you have. You might be on a plan that has certain restrictions, such as to which hospitals they will pay out, while others you pay for not using the approved hospitals. Goes for specialists, which usually must be referred by a GP. Again must be approved GP according to your plan, else the specialist won't also be paid out.

I had no issues with kidney stones, and other medical treatments. I just have the simple Discovery Delta Core plan. I know my hospitals I can 'walk' into. Of course if unconscious and emergency then any hospital will be accepted.

Why the fixation on MSA? It's not a 'benefit' from the medical aid. It's your money. You might as well just pay yourself. The only minor benefit of an MSA is a slight tax break. It's just another con the medical aid industry has come up with to shift the financial burden from themselves to you, all the while convincing you that they're paying for your care.

The point is that we all have medical insurance. We have it because we want to be protected from expensive medical bills if we have an accident. And it's unethical and immoral that they do their level best not to pay when you do have a genuine emergency, be it with fine print or red tape or hiding behind a call-centre.

Originally Posted by proze

Why the fixation on MSA? It's not a 'benefit' from the medical aid. It's your money. You might as well just pay yourself. The only minor benefit of an MSA is a slight tax break. It's just another con the medical aid industry has come up with to shift the financial burden from themselves to you, all the while convincing you that they're paying for your care.

It also acts as an interest-free credit facility, providing all the money upfront. If I save R600/month myself and need R2400 in January, I'd have to find the cash somewhere else. With the MSA I can access it immediately.

I hate dealing with medical aids. My daughter was diagnosed with Isolated growth hormone deficiency over a year ago when she was not growing and we had it checked out. The treatment is available but hellishly expensive. Due to it being such a rare condition, and not technically life threatening (she would be a midget if untreated), the medical aid refused to pay but allowed me to apply for ex gratia assistance. Basically ex gratia is a slush fund that all medical aids have to have for rare stuff that is not covered in any of the usual categories. Ex gratia came back with only being willing to pay 50%. Better than nothing so we cut back on lifestyle and paid our half while constantly fighting for full coverage. According to my daughters specialist its in the medical aids best interest to pay for the growth hormone as otherwise they will probably end up paying for psychiatric treatment for the rest of her life as most people of short stature have mental issues. Still, many medical aids refuse to pay for it. The worst part is that I have no choice in medical aid. As a condition of my employment I have to be on the banks medical aid scheme. According to the doctor Discovery actually is the best at paying for my daughters treatment provided I am on one of their comprehensive plans.

Anyways, finally after a year of fighting and many motivation letters from her doctor right after Christmas they started covering her 100%. Big relief. I was considering moving jobs for no other reason than to get onto a new medical aid as while the treatment is expensive now the dosage is actually weight based so by the time my daughter gets bigger (you treat them till puberty) the cost would quadrupole to about 120K per year. Now even though I found a potentially much better job that would be a big promotion for me and do lots for my own happiness I am seriously considering turning it down in case a new medical aid does not pay for it! All because these guys are so hard to deal with.

@Proze: I completely agree with you that for the situation you where in they should be paying. Fight them! All medical aids in their annual info pack have to have the escalation procedure with the succeeding emails taking you up the scheme. I followed that complaints procedure with my own medical aid and was one email short of complaining to the chief medical officer of the scheme when they finally agreed to pay 100% of our treatment. It is saving me R2500 every month and I can't tell you what a relief it is.

Read again. I'm on a plan with a MSA.

Originally Posted by Cius

Now even though I found a potentially much better job that would be a big promotion for me and do lots for my own happiness I am seriously considering turning it down in case a new medical aid does not pay for it! All because these guys are so hard to deal with.

check with discovery before you turn down the job. never a good idea to turn down a job. plus i think you can continue on your current medical aid even if you leave the company, you just have to pay the monthly in full.

Wow, reading all of this makes me think that all medical aids generally suck with all their rules and regulations. Where are the days where medical aid would cover anything. @ Proze, you can always try and take your story to the Medical Scheme Council like I did with my case, although I can't really tell if the hospital messed up or if you just don't fully understand your benefits (as medical aid companies aren't always clear on that point). My fight with Medihelp (the Necesse option) was that Luke was in a bike accident and was taken to the emergency room where they did some xrays (including a cervical scan) to make sure that his neck and everything else was fine. Medihelp then claimed no because the result of the cervical scan was clear and nothing was wrong they weren't going to pay (this happened in August last year). I fought with them for so long then my medical aid broker told me to write a letter to the Medical Council and send along all the bills and everything to them. Finally in December Medihelp paid as it was part of the PMB and was treated in an emergency so they had to pay up (it was R3k for that scan and I refused to pay). They also didn't want to pay for the emergency room visit as they told me it was an out of network doctor....I mean honestly, where else are you supposed to go in an emergency......I was furious. The Medical Council made them pay for that too. The only thing the medical aid didn't pay for was a small xray that Luke had done when he went back to the specialist to check up on his hip fracture a month after the accident, and they won't pay that because I didn't follow the proper channels as I approved the specialists visit to the specialist but forgot to get authorisation for the scan, which I didn't know I had to but we have settled that now as it was actually my fault. I have now this year upgraded my package though to Dimemsion Prime 1 as it worked out R50 more than the network option and I am not as limited as I was before. Yes there are no dentist benefits or glasses benefits but I prefer to rather have good hospital benefits than those. Anyway, that's my 2c worth, maybe I just got unlucky, who knows. I do suggest having a medical aid broker looking after you though as I don't know all the ins and outs whereas they do, and I only pay them R45 a month to look after me. I also submit all my claims through them and they do all the follow ups and fighting and stuff.

Originally Posted by phalen

check with discovery before you turn down the job. never a good idea to turn down a job. plus i think you can continue on your current medical aid even if you leave the company, you just have to pay the monthly in full.

Not possible unfortunately. Its a closed scheme for Nedbank employee's. The only way to stay on it if you do not work for the bank is if you retired from the bank. Still, I am trying to find out from Discovery if there would be any exclusions should I move over. This thread has just scared me regarding moving to Discovery.