Feb-May 2011 Mommies

Thanks Misty !! I have been a member of discovery since before they were called discovery!! (15 years) and am on classic comprehensive.
I phoned at 12 weeks to register my pregnancy and asked for the forms to be sent. That is the form I filled in. I used all your codes.

The reason for the rejection was something along the lines of ante natal care does not form part of ........ (code for pregnancy!) I mean duh.

I will call them tomorrow and if I don't get an answer I think I will do the Hello Peter thing. It is ridiculous they have taken 9 weeks to decide to reject me!!

zzzzzzzzzzzzzz

Anje, nope Im still with you on not having a name yet We have a list but Im not totally set on anything yet, still looking if I might come up with something better. Enjoy getting those new cupboards!

Lucy, hehe.. little Tessa doesnt like sharing her mommy LOL at the tummy growing a piepie! Oh the scan photies are cute man! And that one is a great side profile

Why would Discovery have declined your PMB???? They are sooo rediculous Maybe you put in the wrong codes? That happened to Vix too and then she just resent the correct ones and they approved her. They really are so frustrating! And phoning them is just going to make you want to go crazy because none of them know what they are talking about!! Ive just sent you an email with my letter and reply I got, along the the guy that sent it's details. Good luck. I still havent heard anything from them on refunding me any of the other claims.. submitted 4 now and only got money back for 1!!??

Meags, ahh so sweet what you do for the Diepsloot kiddies! Im sure there will be sooo many people who miss you when you immigrate Grrrr to those neighbours.. really gross!

Schatsie, how did your appointment go?

Faw, ahhh congrats on joining me with another boy And Im soo happy that all is going so well with him and that he is growing well. I agree with you on how much prices have gone up since our first babas.. shocking!

Aah lucy

They should not decline it a it is LAW as per the council of medical schemes www.medicalschemes.com/

I would contact discovery to find out why it was rejected (are you sure you filled in the right form and all sections etc)? As it is compolsary that they have to accept you they will look for any loop hole to get out of it. If they cant give you a answer then lodge a comlaint with thea above website. I know its a mission and lots of fine print etc but they hope that people will just give up so they do not have to pay! Also write a complaint on hello peter as discovery are fast to respond to this.

I presume you did not join after your pregancy? So cant think of any reason for the rejection?

Ya i would call them - and ask y - and ask to speak to a supervisor or someone who deals with PMBs....good luck and please do not give up!!!

Faw - I had a disappearing willy and you had a growing one- LOL!!! Once you are over the shock you'll come up with the perfect name. How is the bleeding?

Emsmom - It goes quite quickly once you get stuck into it. Glad you could put your feet up. Hope the swelling is easing.

Misty - Thanks for your post! Discovery declined my PMB today!!! Do you think I should try phone them and speak to someone as I have just been doing this via email? I am close to giving up and getting so frustrated! You seem so clued up, hope you don't mind giving your advice.

Hi girls. I had a great scan today. She has however become a he..wtf..lmao.. Yes im having a boy. I saw him loud and proud today. I am now stumped for a name, but im sure it will come. He is healthy and is now 531g. i am happy to see he is growing so much.
Can i also please have an email with that fascinating woman book, i used to have it on my old phone that went swimming in the toilet. Its mmhen21@gmail.com i know its too late for me to try the book out as i have an appointment next week with the mjc and haven't heard from my husband in two weeks.

Meags hope things work out for you. Joli hope you get some time to relax.
Glad i don't have to do christmas shopping but ill be doing baby shopping soon as i get paid and today i went to price things, Yoh they have gone up in two years.
Off to bed now. Night night. Gotta be up at 5am for work again.

Hi girls...

sorry not much time at all fro personals! Ihave had a really busy non stop day.

AngeD - i am not sure if you have a 3 month wait as you joined discovery when already pregnant? What i do know is that you can get your pregnancy preaproaved as a PMB out patient fro all your scans check ups etc. You have to fill in a PMB out patient form and submit it to them. They reveiw them every Thursday. This is not only discovery but all medical aids. Any person on any medical aid plan can get there pregnancy on a PMB (not only the birth, but the whole 9 months). This is a law. But as i said it may not apply to you if you joined when already pregnant? Found this on there site: "

Not all Discovery Health members have access to Prescribed Minimum Benefits
Members who've never belonged to a medical scheme or allowed a break in membership of more than 90 days won't have access to PMBs during either a three-month general waiting period and/or 12-month waiting period on pre-existing conditions. This includes emergency admissions during the three-month general waiting period. We refer to these members as Category A members"

They are so sneeky!!! If you look at the discovery website you will see they do no mention of PMB www.discovery.co.za/portal/loggedout-individual/maternity on the website it mentions nothing about how you can cover your pregnancy on a PMB, but when you dig deeper and ask questions you will find:

"How to get the most out of your cover
Please ensure that you confirm your benefits with us and always know how we cover you for healthcare services, whether done in or out of hospital.
Prescribed Minimum Benefits
Tell us about where you’ll be having your treatment and who your treating doctor is and we’ll confirm if the healthcare provider is one of our designated service providers. If you choose to have your treatment at one of our designated service providers, there will be no shortfall in payment. Remember that any plan benefits still apply in this case.
Prescribed Minimum Benefit is a set of minimum benefits which, by law, must be provided to all medical scheme members. It includes the provision of diagnosis, treatment and care costs of defined set of conditions. Medical schemes have to pay these minimum treatments in full from the risk benefits.
31.03.2010 3
Schemes, on their part, are encouraged to define Designated Service Provider (DSP) networks, apply evidence-based protocols and develop formularies or medicine lists to manage PMBs.
Pregnancy is classified as a Prescribed Minimum Benefit condition, however only certain treatment protocols are available for funding from the PMB risk benefit.
Only when a member chooses to receive treatment outside of the designated service provider, protocols and formularies, does the scheme have the right to apply co-payments.
Please ensure you confirm benefits for all your treatment, whether in- or out-of-hospital, with us. When you call us, we will confirm what cover you have available for GP and specialist consultations as well as investigations.
Cover for consultations, tests and investigations under the Prescribed Minimum Benefits
We will pay for up to eight (8) consultations during your pregnancy at either a GP or specialist that is a designated service provider. If the GP or specialist is not a designated service provider, we will pay these consultations at up to 80% of the Discovery Health Rate and you will need to pay the difference.
You also have cover for eight (8) urine tests (code 4188) and two ultrasounds (one of code 3617 and one of code 3616).
To ensure you have this specified cover under the Prescribed Minimum Benefits:
your doctor has to complete a PMB application form giving us the details of the treatments and codes. Return this completed form by fax to 011 539 2780 or email it to PMB_APP_FORMS@discovery.co.za.
tests and investigations have to be done using a designated service provider and all claims must have the appropriate ICD-10 codes

this is how pregnancy is covered on PMB!

It is very confusing I know! I have the PDF's if you want me to email or if you have any questions I can help you.

AFM: DH is away this week, heartburn has started and still waiting for that first kick!

Hey ladies

Sorry so quiet today, not been very focused today

Meags love sorry you had a crappy day yesterday. Lucky though for your neighbours that you were there! I love knowing that I have aa nurse living near me - we had one across the road from us in my childhood, and became great friends.

So sweet about the Christmas party, please take photos and show us!

Lucy, so lucky to have done your Christmas shopping! I need to finish mine this week, cannot belive I've been so slow this year. Thankfully we finally got the money back from insurance from when DH was hit by that car, so I've got extra spending money
Your scan looks lovely! She is growing so nicely!


Kaylea, glad you had a good week-end, and you know what if your family dont do a babyshower then I think we have a moomie one for you

Schatsie, how did the appointment go? Hope all is alright.

Ok sorry about those I forgot I promise I'll try remember everyone next time.

AFM had to lovely lazy week-end - the last one till enxt year! Had FIL birthday last night and they have NO friends, so was just us 3, them and my folks. When we had told Em we were going to pa's party she was expecting lots of people and a jumping castle, and really couldn't understand why were called going there for supper a party... (to be honest I dont understand either...) But still. Today had to take friends to the airport and then just chilled and worked. Doing all work in bed now so I can keep my feet up so help the swelling a bit.
Baby is moving tons now, esp when I listen to music. Far too cute!