********* behavior from Discover Medical Aid

What a pathetic excuse of medical aid! I am on the Discovery Executive plan paying in excess of R25 000 per month! I had to go into hospital for an in theatre procedure on 26 October 2023, and called Discovery to get authorisation on 25 October 2023. The doctor sent me a letter stating the procedure codes and motivating for the procedures I required, I gave the consultant all the information of the procedures and practice numbers of the doctors and hospital, after which it was confirmed that everything would be covered except for the facet joint injections (only one of the procedures, but the doctor already informed me of this beforehand) I asked the lady if I needed to send the letter/motivation from the doctor, but she confirmed that I do not need to send and additional motivation or letters since the procedures has been approved. She gave me the authorisation number, and I received an e-mail (apparently from Dr Ronald Whelan (Chief Commercial Officer) according to the signature on the bottom of the letter)

I went in for the procedure on 26 October 2023, and on 27 October 2023 I received another e-mail from Discovery, again from the so-called Ronald Whelan... stating that they have reviewed my authorisation and declined funding (THIS AFTER I ALREADY HAD THE PROCEDURES DONE!!!)

The most pathetic reason as stated in the letter is quoted below: "Our role is to ensure members of the Scheme enjoy access to quality healthcare in a way that remains affordable and sustainable. Some of the ways we achieve this is in our Plan and benefit design, the creation and application of funding policies and clinical protocols which are developed using a rigorous, evidence-based decision-making process. This process also helps us make decisions about which procedures and treatment to exclude from cover."

I will be taking this case to the Medical Insurance Ombudsman because of this ********* behavior from a Medical aid that is only trying to make the members pay the maximum premiums, and cover the minimum...