1 reviews | Active since Nov 2018
ART Claim Rejections Causing Treatment Interruption
I am extremely dissatisfied with Discovery Medical Aid’s handling of my Assisted Reproductive Therapy (ART) claims.
My claim for embryo freezing and storage, which is an essential and integral part of an approved ART cycle, was rejected using rejection reason 6, stating that I “do not have this benefit.” This is factually incorrect. At the time of rejection, only 43% of my ART benefit had been utilised, meaning sufficient benefit remained available.
This is not the first occurrence. The same rejection reason was used last year to decline my ART-related claims. After prolonged delays and disputes, Discovery ultimately paid less than half of the required amount, and only two days before my scheduled embryo transfer, placing me under immense financial, emotional, and medical stress.
The current claim was submitted last year, yet remains unpaid. As a result, my fertility clinic has advised that I cannot receive further treatment until the outstanding amount is settled. This has placed my 15 January appointment at risk, where my doctor is meant to confirm whether my pregnancy is progressing.
Additionally, due to Discovery’s refusal to settle this claim, I am now unable to obtain a prescription for my fertility medication, and my injection medication is almost finished. This interruption places my treatment and pregnancy at serious risk and is a direct consequence of Discovery’s administrative failures.
Discovery’s repeated misapplication of benefit rules, delayed payments, and lack of accountability have directly interfered with my medical care. This level of service is unacceptable for a medical aid entrusted with critical, time-sensitive treatment.
If this matter is not resolved urgently, I will have no alternative but to escalate the complaint formally.
We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible.
Regards Discovery Health Servicing Team
We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible.
Regards Discovery Health Servicing Team
One of Discovery’s consultants called me and assured me that she would communicate with the hospital so that I could be assisted, and promised to update me the following morning. Based on this assurance, I stayed at home the entire day without my medication, waiting for a call or an email from Discovery. Nothing happened. No call. No email. No authorisation.
Later, I received an email from the hospital stating that I may only receive my medication if I pay the full amount upfront — R11 749.43 — because Discovery has not paid. The invoice was issued on 28 November 2025 and is due upon presentation. The hospital further advised that I can only be refunded if Discovery eventually pays and the amount is allocated to my file.
This medication is critical and time-sensitive IVF medication. Any delay or missed dose can jeopardise an entire treatment cycle. Discovery’s lack of urgency, poor communication, and repeated rejection of a claim that was submitted last year has placed my fertility treatment at risk and caused extreme emotional distress.
It is unacceptable for a medical aid to make promises, fail to act, and leave a patient without life-changing, time-sensitive medication. This experience shows a complete lack of accountability and patient-centred care from Discovery.
One of Discovery’s consultants called me and assured me that she would communicate with the hospital so that I could be assisted, and promised to update me the following morning. Based on this assurance, I stayed at home the entire day without my medication, waiting for a call or an email from Discovery. Nothing happened. No call. No email. No authorisation.
Later, I received an email from the hospital stating that I may only receive my medication if I pay the full amount upfront — R11 749.43 — because Discovery has not paid. The invoice was issued on 28 November 2025 and is due upon presentation. The hospital further advised that I can only be refunded if Discovery eventually pays and the amount is allocated to my file.
This medication is critical and time-sensitive IVF medication. Any delay or missed dose can jeopardise an entire treatment cycle. Discovery’s lack of urgency, poor communication, and repeated rejection of a claim that was submitted last year has placed my fertility treatment at risk and caused extreme emotional distress.
It is unacceptable for a medical aid to make promises, fail to act, and leave a patient without life-changing, time-sensitive medication. This experience shows a complete lack of accountability and patient-centred care from Discovery.
My claim was successfully submitted on 18 December 2025, with claim number ***. Despite this, Discovery informed my medical provider that the claim was only submitted in January 2026, which is false. January communication was strictly a follow-up, not a submission.
I was further told that I “do not have that option” when querying the matter, with no proper explanation or accountability. As a result of this misinformation, my healthcare provider refused to release time-sensitive medication, directly impacting my medical treatment.
Providing incorrect information and dismissing members without clear justification is unacceptable, especially in critical healthcare situations.
My claim was successfully submitted on 18 December 2025, with claim number ***. Despite this, Discovery informed my medical provider that the claim was only submitted in January 2026, which is false. January communication was strictly a follow-up, not a submission.
I was further told that I “do not have that option” when querying the matter, with no proper explanation or accountability. As a result of this misinformation, my healthcare provider refused to release time-sensitive medication, directly impacting my medical treatment.
Providing incorrect information and dismissing members without clear justification is unacceptable, especially in critical healthcare situations.
We have been in touch with you to answer your comments.
Regards
Discovery Health Servicing Team
We have been in touch with you to answer your comments.
Regards
Discovery Health Servicing Team