An eternal hassle

Item: Discovery Health
Rating: 2
Author: Stefanie D

Our baby girl was born four weeks prematurely on 3 Mar. via emergency C-section at Park Lane clinic. We had originally planned a water birth at Genesis Clinic, but at the 36 week gynea visit were diagnosed with absent end diastolic flow (AEDF) as well as in utero growth retardation (IUGR). The gynae considered it necessary to do an emergency C-section and referred us to Park Lane, which is equipped with a good neo natal unit that would be required due to the baby's prematurity. We were told to proceed to the hospital right away and the C-section was performed a few hours later on the same day. Our gynea has written a motivation explaining that this was an emergency procedure and that the choice of clinic was made in the baby's best interest; however, Discovery refuses to refund us for the co-paying that we were forced to make and keeps telling us that our C-section was a planned procedure - contrary to the doctor's motivation letter. Not sure how they know better than we and our doctor whether or not the procedure was \planned\", but not surprisingly it is once again a gigantic hassle I now have to deal with on top of a premature baby that was only at birth diagnosed as Down syndrom"

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Replies (2)

Discovery Health's replyOfficial

08 Apr 2016, 10:48

Hello Stefaniedose,

Thank you for your comment.

We tried contacting you but you were unable to take our call.

We referred your appeal request to waive the out of network deductible for Ms Dose's admission at Parklane clinic on 03/03/2016 to our medical review team for a funding decision. We regret to advise you that your appeal to waive the out of network deductible remains declined.

I have confirmed that final feedback was sent to you via email from Nompomelelo.

I understand this is not the outcome you hoped for and I am sorry we could not provide a more suitable resolution on this.

Regards
Fazeela

Discovery Health's reply08 Apr 2016, 10:48

Official

Stefanie D's updateReviewer Update

30 May 2016, 11:15

1. Claim that there were other network hospitals in closer proximity: This is BS. Please send me a list of hospitals with neonatal ICUs that are closer than Netcare's Park Lane clinic. (Please be reminded that the decision for the emergency c-section was taken not at our residential address, but at the doctor's consulting rooms during a check up, at 35 Bartlett Road in Braamfontein. This address, and not our residential address, should therefore serve as the centre for the search for nearby, adequately equipped, hopsitals. 2. For the record, it is ridiculous to expect of patients confronted with an emergency situation to first search your network for network hospitals, then compare these against Google Maps to determine their distance from the patient's location, and then proceed to the nearest network hospital. Your policy states that, in case of an emergency (which my doctor has certified), any hospital, even if outside the network, may be used. It is ******* of you to decide not to apply this policy as it pleases you. Please forward me the relevant extract from Discovery's policy which states that in case of an emergency, the patient may not in fact use the nearest hospital but first needs to determine whether another network hospital is in equally close proximity. 3. You are changing your story. First we were told that this was not an emergency; now, after the doctor's note, you suddenly claim that it was an emergency, but there are other reasons why you cannot pay the claim. Nice try.

Stefanie D's update30 May 2016, 11:15

Reviewer Update