DISCHEM MEDICAL INSURANCE A RACKET - BEWARE OF THEM!!

My name is Johan I have been a member of Dischem Health Medical Insurance since 2023. I am 63 years of age. We just moved down from East London to Helderview ,on the night of 3 August 2025 I was carrying a box, it was dark, I had an legitimate accident, I accidently slipped and fell down and injured my left wrist and arm would not move sideways - the next morning x rays confirmed I tore my rotator cuff clean off , which explained the excruciating pain. I took a hot shower, attended to my visible wounds and took heavy pain medication.

Around 11:45 I could still not sleep, I could no longer bear the pain and my pensioner wife googled the nearest ICU, and drove me to the Vergelegen Medicross.

We followed the Emergency signboards, I noted the parking lot was dead quiet, with very few parked vehicles, once we arrived at the Emergency Department, there is a tar drive through under roof area, but the aluminium entrance doors was locked, we looked inside, but did not see anybody through the locked glass doors, eventually we had to leave without being able to see any hospital staff.

The next morning, 4 August 2025 at 7:45 we went back to Vergelegen Medicross , we were directed to another entrance on the back of the building, the place was very crowded, I waited about an hour before I was asked to register on their computer, the reception staff contacted Dischem Health / Kaela and first obtained reference number *** which authorized me to see a Dr. van Gruting, after waiting close to 3 hours ,who send me for X-rays, he mentioned x-rays do not show bone break, his referral report prognosis was "suspected Rotator cuff tear" he wanted to send me for a sonar scan in ER but there was a problem and the one machine was broken, dr. said they would not be able to do the scan immediately and he gave me a medical referral letter on the Emergency Department letterhead stating Winelands Radiology Diagnostic Radiologists must book me for the scan ER was not equipped to do at that stage, the scan appointment was only two days later, on 6 August 2025 at 11:30. I was issued a script for pain medication and told once the scan was done the scan Dr. would forward his report to the ER Dr. Dr. van Gruting who would decide how to deal with my ER injury.

With a lot of effort I had to personally phone and send no less than 5 x email's to Dischem Health / Kaelo - I eventually managed to get authorization, reference nr. 389 706 756. On 6 August 2025 Dr. S Scheepers examined the x-rays and confirmed Dr.van Grutind from ER's prognosis that my Rotator Cuff had indeed torn right off the bone , he confirmed the sonar showed there was heavy inflammation , fluid distention etc. which Dr. Scheepers explained was the reason for the excruciating pain. Every time I move my arm it feel like there is a knife in my shoulder that is twisted.

Next step I was told to arrange an appointment with Charl van den Berg a specialist orthopedic and shoulder Surgeon for 12 August 2025. After five plus e-mails and calls Ella from Dischem /Kaelo eventually issued me with Authorization reference *** second approval ***7 , fortunately I recorded our conversation, BECAUSE ON 13 AUGUST 2025 THE SUPPLIER SEND ME AN EMAIL THAT THE AUTHORISATION WAS WITHDRAWN AFTER I TOOK THE EXPENSIVE SCAN.

I am of the opinion it is highly embarrassing to give authorization then without consulting me or the Dr. to one-sidedly with draw their authorization and explicit undertaking to pay the account in full... beware of this if you should consider dealing with Kaelo/Dischem!! When I arrived at Dr. v d Bergs rooms for my appointment I had to pay the consultation fee of R1200.00 up front!!

On 12 Aug 2025 Dr Charl van den Berg send a report to Dischem Kaelo his finding was there is a full thickness tear, he confirmed the previous two doctors was correct and that the left rotator cuff tendon was cleanly torn in half, and he warn that if the shoulder is not operated as a matter of priority it would lead to further tendon retraction, muscle atrophy and progression to an irreparable tear, leading to PERMANENT DISABILITY . The shoulder specialist state an operation is the only way to restore use of my arm, restore shoulder strength and to prevent chronic pain, etc.

People I would seriously warn you not to trapped by the lower rates to belong to Dischem/Kaelo. As a patient in extreme pain you will have to try and get your own authorizations approved from Dischem/Kaelo. After begging and threatening case managers they will reluctantly issue authorizations, which they then reverse , and you are stuck with the account.

My operation was scheduled for 25 August 2025 I have send approximately ten or more emails and all three the doctors reports and recommendations, after a week lapsed the surgeon and the theater cancelled the theatre booking for lack of authorisation.

Dischem/ Kaelas reason for not approving the emergency operation BELIEVE THIS OR NOR - THEY SAY BECAUSE THE ER DEPARTMENT COULD NOT HELP ME BECAUSE I WAS NOT TREATED IN FULL AND NOT IMMEDIATEDLY!!! THE DELAYS WAS NOT ON ME THE PATIENT'S SIDE, THE HOSPITAL COULD NOT DO A SCAN DUE TO A BROKEN MACHINE AND/OR BEING TOO BUSY , AND NOW FOR THE LAMEST EXCUSE, BECAUSE THE ER DR VON GRUNTING DISMISSED ME FROM ER, THE MOMENT I WALKED OUT THE DOOR MY CLAIM WAS REPUDIATED BECAUSE THE ER STAFF DID NOT HAVE THE CAPACITY TO TO AN ER SONAR AND TO OPERATE IMMEDIATEDLY.

BE CAREFULL PEOPLE - I HAD AN ACCIDENT, MY SHOULDER DAMAGED BEYOND USE, DISCHEM DELAY AUTHORISATIONS AND GIVE LATE AUTHORISATIONS WHICH THEY REVERSE AS THEY PLEASE, WHY DID THEY GIVE ME AUTH TO GO FOR E RAYS, TO GO FOR SCANS AND AUTH TO SEE THE SHOULDER SPECIALIST TO TURN AROUND NEARLY 20 DAYS LATER AND SAY THE PATIENT DID NOT ACT SPEEDILY ENOUGH THAT IS WHY THEY ARE PULLING BACK

YOU WILL BURN YOUR FINGERS WITH DISCHEM KAELO THEY JUST WANT YOUR MONEY

JOHAN