Approval of Hospital Admission then a day later Approval Declined

Good-day

I can’t express the incompetence of Discovery that I have had to deal with lately since I have been sick. It has been an absolute nightmare only adding to my sickness.

I also can’t express the ************** received seemingly since I am on a low plan.

Let me give you some background.

I have been a Discovery member since 2018 and had a break in service for 2 months during May/June 2023 and then came back onto a lower plan due to financial setbacks.

For the past month (approx. 10th Dec) I have been up and done to several network doctors (All part of Intercare) for treatment for severe stomach pain. Diagnosed with possible PUD etc I have been treated with antibiotics, PPI’s etc with no resolution. I have paid for every single medication out of my own pocket amounting to over R3000 ( check my records and claims please). I have lived with this pain for over a month.

On the 22nd Jan I did a telephonic consultation with a doctor as I could not handle the pain any longer and also was unbearable to drive to doctor, she advised me to go to casualty and make sure I use a Network hospital in case I get admitted. On the 23th Jan 2024 I went to Lynwood Hospital casualty (Network Hospital) with severe pain put on a drip of Parfalagan, Buscopan and Inhibitors sent for bloods and xrays (all of which I have paid from my own pocket including casualty fees which I am owing), pain did not subside. The doctor on duty said they will admit me to run further tests, this did not happen as the senior doctor advised they do not admit for PUD but I must go for a urgent scope.

Again after a rough ride with Discovery the scope was finally authorised to be done in a doctors rooms. Please once again check your notes on my account to see the headache I endured just to get this approval. I did the scope through Dr Lloyd Vambe who is not a DSP however was the only doctor who I found who could accommodate me urgently and who does scopes in their rooms (this is the cheapest option) as there was no co-payment.

After the scope was done the doctor advised me that I need surgery as the valve is no longer working and theres a Hernia. Authorisation was requested for surgery to be done the very next day (today 26th January) and authorisation was received. Please see attached. I was however advised that since the hospital is not on the DSP Network list I would have to pay a co-payment of R14K.

This morning since 6am I prepared myself to go in and was awaiting times from doctors only to be surprised that the doctors rooms have now withdrawn the authorisation (approximately 9am) pending a motivation from the doctor.

Moments later I was then told theres no need for motivation as it is a general conclusion.

Theres a series of several calls made by myself and the doctors rooms to Discovery health with Simone and Laura.

I then called into Discovery and spoke to Mandisa she advised me that there’s notes on the system saying they waiting for motivation from doctor. I asked her can I speak to someone more senior who can give me proper answers. She dropped the call and till now 11.01 she has not called back.

I then called in at 11.19 and spoke to Kedi advising me that it still says they need a motivational letter.

I don’t understand how Discovery can approve something then remove it the very next day. This is not surgery that I am electing to be done for fun.

As mentioned above I have been back and forth with stomach pain and other presenting symptoms and have been on medication day in day at. My day to day life is been severely affected as there are times when I cannot sit up straight due to pain in my abdomen. ( All these records and complaints can be found at my network doctors at Intercare) I cannot live this way with a feeling that my stomach is going to burst at any time.