Can Someone Please Explain This To Me?

This is a “rant” of sorts, no- not of sorts- it is a rant, but I can’t wait till next Thursday!
I joined a new medical aid scheme at the beginning of May when I changed jobs. I opted not to take the medical savings plan they had because I couldn’t afford to pay them any more than I was already paying them (over R1K/m for me and Damien). What then happened is that I had to pay a for certain amount of claims- up to a specified amount- before they started paying claims for me. I did this- for five months. The self payment gap is now covered and they say they are paying the NEW claims. So- this morning I went onto their website in order to find out what would be happening with psychiatric claims since Damien and I are to start seeing the psych (the one that was recommended by the other psych that we saw on Wednesday) next week. She wants cash up front, I don’t have it, so I wanted to make sure the medical aid would pay her. It turns out there’s no problem paying her, we just follow standard procedure. Then I saw, on my “available benefits” screen, that my optical benefit is on a zero! So I got on the phone to my medical aid supplier to ask who they paid since I paid for my own glasses in May (it was before the self payment gap had been covered so I had no choice). He gave me the name of the same supplier I paid. So I asked the guy how come it said my benefit was finished if I had paid for the glasses myself. He went on to inform me (in what turned into a 11 minute 36 second roundabout conversation) that any and all claims will reduce my benefits in order to reach my threshold, even if I pay it myself. I asked how come my benefit decreased if I wasn’t actually benefiting from it. He repeated himself in slightly different words. I said I could not fathom the logic behind this. He said: “That’s how it works. That’s how it’s structured.” I said: “Thanx for nothing” and hung up. I didn’t swear at him and I didn’t raise my voice, but I hung up before the hysterical giggling set in. I still don’t get it though. To my mind- if I paid for it so I didn’t benefit from having a medical aid. Does anyone out there understand how this works? Does anyone out there actually have a medical aid that works for them i.s.o. vice versa?

One thought on “Can Someone Please Explain This To Me?

  1. Uuuummmm, no. I cant, i have NO idea what happens with my medical aid. I am completely clueless when it comes to stuff like this. Sorry for this totally useless comment.

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