Discovery Keycare Plus / discovery not paying for specialist visits

Cape Town, South Africa

I am a discovery keycare member. i pay R4700 a month for me and my family. this is the lowest plan discovery offers their benefits are not bad but limited. i was diagnosed with Graves Disease in January this year by my GP. Keycare offers an annual specialist benefit of R3000 per member. keycare does not have an endocrinologist on their specialist panel but I was given the go ahead via email from people at Discovery to go and see one at Christiaan Barnard Hospital. my GP followed procedure and applied for me to see a specialist. i went for my first specialist visit in March and I had to pay R1400 and claim back from Discovery. I did this and got an email from Discovery advising they will refund R300, I have yet to receive this refund. my second visit to the specialist was in May and I had to pay R700. i was told that Discovery would look into refunding me if I paid a shortfall of R80 that was reflecting on my account. I paid this R80 only to be told that Discovery were not going to refund me any of the monies I have spent. I have to buy medication monthly at a cost of R800 which Discovery does not cover at all. I was then told that the specialist benefit my GP applied for expired on the 22nd of July, after my first visit, but they still did not cover any of my visits. how is this acceptable? yes its the lowest plan? but its still alot of money every month that I have to pay. In march I was admitted in the emergency room for dehydration, I had to pay for the blood tests that was done in the hospital. I also received a bill a week later from the hospital for R500+ that I had to pay due to my medical aid not covering? I honestly cannot understand the point of having medical aid, to pay so much money every month and then not get cover when you need it. why bother having medical aid?

Jun 5, 2015

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