Deeply Disappointed

I'm deeply disappointed at the service I've recently received from Discovery Health. I took the cover in June this year. I recently found out that I will be needing surgery for the torn tendon in my shoulder instead of just simple physiotherapy as I had expected. Under the Essential Smart Plan which I'm with , I should be covered for hospitalization. However, I was informed by the Orthopedic surgeons receptionist that under this plan, I would not be covered 100% thus would need to fund the rest. I had asked the receptionist to inform once she knows how much will be covered, and how much I will need to add to the bill. Till this day (this happened before the end of October) I haven't received word from Discovery. I've called the doctors rooms, and they have said they are still waiting for Discovery to give authorization. Instead, I received a phone call from a sales person from Discovery interrogating me about when I had seen the doctors before the decision was made that I would be needing surgery. She kept asking me if I had seen a GP first before I had seen the Chiropractor , who then advised that I see the Orthopedic Surgeon after many tests. Still she kept asking about the GP. Now, I can only assume that Discovery is investigating or insinuating something since it hasn't been too long since I've had cover with the medical insurer, and that perhaps I had known about needing the surgery before which is not true.

I'm in a lot of pain at the moment, I can barely lift my arm and living on pain-killers. I had no idea that my shoulder was injured to such a degree that surgery would be required, hence I went to the chiropractor first. If I had known that I needed to go to a GP first, then I would have done that. I was under the impression that It was inflammation or that I had just slept on my arm badly, or even the beginning of arthritis.

I never expected this kind of treatment from a reputable health insurer such as Discovery. If it is mandatory to see a GP before seeing a surgeon or if there are T&C's before they are willing to really cover their clients, I wish that I and other clients are informed so that we know what to look out for or claim from the medical aid.

For me this really shows, that all medical aid insurers as well as all insurers are just money making schemes. They are happy to take money from their clients monthly, however despondent and drag their feet when it's time to really do their jobs.

Very disappointing.

To the general public, ask the right and all the necessary questions before taking a cover with any insurer. This is a lesson learned for me.