CHRONIC BENEFIT IS A MYTH WITH DISCOVERY

I joined Discovery Health Medical Scheme with a pre-existing chronic condition of epilepsy. Prior to enrolling in the Classic Delta Saver plan, I confirmed with your representative that I could continue seeing my existing neurologist without issue. However, upon attempting to schedule my annual check-up, I was informed that I could only receive full coverage by consulting specific doctors designated by Discovery Health.

The nearest designated neurologist available under my plan was approximately 40km away from my residence. Despite this inconvenience, I scheduled an appointment with the prescribed neurologist in good faith. During this initial consultation, which was my first time seeing this doctor, he conducted a comprehensive examination, necessitating various tests and procedures to properly assess my condition.

Subsequently, I received a bill totaling R6,184.48 for the consultation. Discovery Health covered only R1,658.58 from the Prescribed Minimum Benefits (PMB), and the remainder was deducted from my Medical Savings Account (MSA) until it was exhausted. I was left with an outstanding balance of R1,118.65, which I am now required to settle directly with the neurologist.

Upon contacting your customer service department to dispute this matter, I was informed that certain codes and procedures used during the consultation were not covered under my registered condition. Specifically, I was told that the cardiac-related codes were excluded from coverage, why would a Neurologist perform cardiac tests if they won't fall under the PMB? It's not like a had holter monitor on, these cardiac tests were basic tests that could also be done by a GP. As a neurologist, all aspects of my consultation should logically fall under the coverage for neurological care, especially considering the doctor was designated by Discovery Health.

I am deeply dissatisfied with this outcome and feel misled regarding the coverage of services under my plan. I urge you to reconsider your decision and provide full reimbur*****t for the consultation, as it was conducted by the neurologist prescribed by Discovery Health for my condition. It is unreasonable to expect me to be knowledgeable about the specific codes and procedures covered under my plan when selecting a designated healthcare provider prescribed by you