About 4 years ago, my husband and I took out Gapcover as we have a standard medical aid. The consultant told us that when ever we are hospitalised, need a Opp or need to see a specialist and the medical aid does not cover the entire procedure the Gapcover will cover the "Gap". Last year my husband went for a knee Opp. The medical aid only paid a portion and there was a shortfall of R1900. I contacted Old Mutual to claim. I was then informed that if our medical aid did not pay for certain instuments used for the Opp, they can not process the claim. I went see a specialist in May of this year. We needed to pay R1080. I tried to claim the amount from our medical aid, but the specialist charged a higher rate than the medical aid so again the medical aid only paid out a portion. I contacted Old Mutual again, thinking that this time I do have a legit claim. After 4 days I received an email that said that they do not cover specialist consultations. I explained to them that the specialist did a procedure in hospital! She said that if the medical aid does not cover the procedure, they dont cover the procedure because there's no gap to fil! What do they cover? Paid over R5000 already!!!
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