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?

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About Angel

Wife, mom, cake artist, Guide Dog puppy raiser, ADHD champion, wedding planner, and tattooed cat slave.

One Response to Can Someone Please Explain This To Me?

  1. spookie says:

    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.