Covered? No, not covered

I recently had an interaction with Discovery and I wasn't given an opportunity to rate the interaction with the call centre. I recently was referred to the ER by the dentist for a tooth root that had gone through my sinus cavity. When I got to the ER (Network Hospital), the receptionist advised that I would need to pay between R2000 and R4000 to be seen to by the doctors as my plan did cover ER attendance (?). The maxillo-facial surgeon was unable to see me and the kind staff at the ER managed to arrange that I get an early appointment with the specialist, first thing on the Monday morning. After attending the consult (R4000 which I paid cash for as I know my plan doesn't cover this), I was told I need to go for a procedure (deemed urgent) to remove the root of the tooth and I would need stitches to close the hole.

I then called went back to my plan marketing booklet which luckily had a section referring to Severe Dental Benefit which I hoped would be applicable to my case. I arranged two quotes from the specialist, one for in-network and one out of network.

Once I had the prices, I called the call centre to check whether any of these authorisation codes are covered on my plan. The initial lady I spoke to confirmed that the codes fall under the Severed Dental Benefit and then put me through to the Client Service Agent. She confirmed that 3 out of the 4 codes were covered and that the phone call was was sufficient, no pre-authorisation was required. I asked quite a bit of questions to understand what the co-payments would be etc. Almost 20 minutes of conversation later, she realised that the codes are actually NOT covered by my plan (Essential Smart) but actually on the (Classic Smart), one plan up. To say that I was disappointed is a huge understatement. From an initial co-payment of R5700 which I would have happily paid, I am now responsible for the full bill - a total of R42 000.

I held on the line to rate the call but the call was disconnected. I also waited for a survey email and did not receive one, hence resorting to Hello Peter.

When going back to the booklet, the following is written: "In hospital dentistry is not covered on the Essential Smart plan. Except where you are approved for severe dental and oral surgery, you need to pay a portion of your hospital or day clinic account upfront for dental admissions...". And as previously mentioned, the codes I gave them definitely fall within that category.

Seriously re-considering whether it is worthwhile to stay with Discovery.