Julz - Discovery.

Vix you can say that again time flies. I cant believe you are already 9 weeks. In no time I will be writitng my birth story.

Congats Huggles your leter looks similatr to mine except I have asked to be reimbursed esp. for bloods coz there is no dsp on those.

Charney any money back to our savings is good esp. since I have LG atleast if she gets sick I wont worry there will be cash for her and hubby to use.I am just glad I will get something esp. since I knew nothing about this pmb.

Ginah - just want to tell you that you might get back 'LESS' than you were getting before. 50% of your gynae rate that you were getting back is probably 100% of the Discovery rate, now you are going to be getting back only 80% of the Discovery rate, not of your gynae rate.

But, remember, this now doesn't come from your savings anymore, so you will be saving in the long run.

Ok, so after sending in the wrong forms and then finally getting the correct forms and completing those and sending those in, I have just received my "approval" from Discovery.

Only thing is, they are only covering me from 27 May to 30 Dec 2010 - so i can't claim for any of the appointments i've already been to!

Below is my "approval" letter:

We reviewed your request to fund Mrs.[Huggles] out-of-hospital treatment for Consultation and tests as a Prescribed Minimum Benefit (PMB).

This letter confirms that we have approved funding from the Hospital Benefit as a Prescribed Minimum Benefit for this treatment. The Prescribed Minimum Benefit entitlement for Supervision of high-risk pregnancy unspecified, (52N), stipulates the following provision; (Antenatal and obstetric care necessitating hospitalisation, including delivery). Our approval is in accordance with this provision. Approval is from 27 May 2010 till the 30 September 2010.

Below are the details of the specific codes for the consultations and investigative tests we have confirmed. It also explains why you should use our designated service provider for us to pay these accounts in full.

We have confirmed the following codes

Consultation codes0192(Consultations) x8
Investigations and tests4188(Urine dipstix) x8 and 3615 and 3617 x1


You should use our designated service provider

You must use the Scheme's designated service provider for these consultations and tests for us to pay the accounts in full. Our designated service providers agree to charge the Discovery Health Rate for these services. This year our designated service provider for out-of-hospital treatment is:



specialists who have agreed to charge the Discovery Health Premier Rate.

If you choose to use a healthcare professional who is not one of our designated service providers, Discovery Health will pay your account at 80% of the Discovery Health Rate. You will be responsible for paying the difference from your pocket.

Dr Truter is not a DSP

Payment does not come from your day-to-day benefits

As we have confirmed the funding as a Prescribed Minimum Benefit, expenses will be paid by the Scheme and not from your day-to-day benefits or your pocket. This is in accordance with the Medical Schemes Act.



You can contact us to find out if your healthcare professional is a designated service provider

Call us on 0860 99 88 77 if you want to find out if a doctor is a designated service provider.

I hope this explains how we pay your accounts as a Prescribed Minimum Benefit. You'll find more information on www.discovery.co.za

Kind regards

DiscoveryCare: Solution Services

Vix I didn't fill in any forms as I'm claiming back from last year. But I believe it is the "out of hospital" prescribed minimum benefits for pregnancy forms. If you send them the "in hospital" form then it might affect your hospital cover. Someone please correct me if I'm wrong?!?

Thanks guys!

Ginah- can't believe you're 24w already! Where does the time go?

Kristin- thanks for the info! Do you still have the forms on your PC? I am totally confused which are the right forms and if I phone discovery I might just throttle someone becvause any call centre from any company is useless!

Janine- they really gave you a hard time hey!

Yeah:) also got approved just need to findout how much I will be getting back. Have been getting 50% back all along and now will get 80% back as my gynae is not a DSP.

Thanks Julz and to the other lady from PF who brought this up. We wouldnt have known about this pmb stuff.

Shoki my broker handled it.

BUT

It is NOT up to your gynae to inform you of how your medical aid will cover you. That is a silly argument. Your gynae's job is to care for you and your baby. It's your medical aid's job to inform you of such. I would continue fighting them. I have been told that once I have my ducks in a row I must go to the walk in customer care centre at canal walk and sit down with a consultant there and go through each account 1 at a time. Maybe you should go to a walk in centre and sit down with someone and talk it through. The cannot decide to help some and not others.