LETTER: A flaw in Discovery’s operation
Medical scheme does not distinguish between general practitioners and specialists
Up front let me express my admiration for Discovery Health’s operation and almost complete satisfaction with its member benefits. It’s a highly professional, well-run organisation.
The one exception is its attitude towards medical specialist consulting fees. It does not distinguish between general practitioners and specialists, although specialist consultations are normally far more detailed and of longer duration. In addition, its self-trumpeted schedule of “contracted doctors” including specialists with whom they have fee arrangements, is highly unimpressive.
Unfortunately, I required some specialist treatment lately. I called Discovery to see whether it could recommend specialists close to my area with whom it has a fee arrangement. It was a comedy of errors, with Discovery initially recommending doctors in Cape Town (I live in Johannesburg) and then others as far away as Pretoria. Alternatively, if I didn’t value my safety, Hillbrow, Yeoville and the Johannesburg city centre were also options.
Discovery also told me its consultation rate for specialists is about R400 per consultation, “around the average rate charged”. I made many calls only to find that the average rate is closer to three times this amount. I then selected and consulted with a few specialists from its website. They refunded me R1,500 on a charge of R5,900 (25%) and R1,500 on a charge of R4,000 (37.5%).
Of course, if you are not ill there’s no problem. If you require surgery you are fine as long as you have a gap policy, which involves another charge. Of course, there are specialists who charge excessive fees, which forms the basis of Discovery’s poor defence.
During all this time I attempted to speak directly to the CEO of Discovery Health, but he didn’t have the time. For the record, its reimbursement rate for specialists is identical to that of general practitioners. However you look at it, this is a rip-off. But Discovery does have beautiful state-of-the-art headquarters.
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