Discover Discovery Health

The Cambridge English dictionary defines the word as"discovery noun (FINDING) B2 [ C or U ] the process of finding information, a place, or an object, especially for the first time." This is so appropriate, when I decided to move from Momentum to Discovery medical aid a while ago, a friend said to me"Discovery is a great company as long as you are not sick".

I decided to move to Discovery on 1 December 2018, and my son was hugely impressed. When you are young and active, you get gym membership, Apple watches, discounted health food and God knows what for next to nothing. They must be spending a fortune on all the lifestyle gimmicks that are so fashionable at the moment.

My discovery came on 29 December 2018. I am 62, very active and fit and I love walking my Yorkies on the beach (when I am there). For years my practice is to walk 6 kms, and never ever did I suffer any discomfort or pain. The 29th was no different. After my walk I wanted to water the garden, and I bent down to pick up the hosepipe. The next moment I felt an excruciating pain, and as I wanted to get back up I literally passed out and fell to the lawn. My wife thought I had a heart attack, and rushed to my assistance.

With the help of a neighbor I was taken to a doctor, who explained to me that I probably slipped a disc in my back and it pinched a nerve. He gave me an injection, pain tablets and told me that I would have do a scan to be certain. He suggested that I wait a while to see if it gets better.

It did not get a lot better. I could stand up and walk, but with a lot of discomfort. As long as I was lying down or sitting, it was OK. However, that is not really why we go on holiday. On 8 January I flew my son down to help me drive my wife and I back to Sandton (I wanted to do the scan in Johannesburg).

I approached a client and friend of mine, Dr Rene Jansen van Rensburg (Van Rensburg and Partners) and on Friday 11 January they did the MRI scan. Immediately afterwards he told me that he had very bad news for me. He showed me that Lumbar vertebra L5 had basically disintegrated, and when I bent down L4 slipped forward and is now pinching the nerve. There is literally no gap for the nerve, and it is not going to "fix itself". He is always very anti-operations, but told me it was the only way out. He immediately referred me to his colleague Dr Schalk Burger, a neurosurgeon and a man he has a lot of confidence in.

After Dr Burger examined me and studied the scan, he came to the same conclusion. He pointed out that my right foot already showed signs of so-called "drop foot" because of the pinched nerve, and that if left for too long I could suffer irreparable damage. With all of this ****ing evidence, I made up my mind. There is no other solution, hate it or not, it is what I will have to do.

The only thing left to do was to get Discovery approval for the process. Ha-ha. A little bit of history. I was a discovery client for years, until I joined IBM in 1996 and moved to New York. When I came back to South Africa and re-joined FirstRand (Momentum) in 2000, I joined Momentum Health and was a client of theirs until end November 2018. So you can see, I have always paid my dues in terms of medical aids. Before I signed the Discovery application, I saw the "3 months general exclusion" clause and I called the administrator to discuss. I was told that in the case of emergencies it does not apply, and that it is covered by the so-called "prescribed minimum benefits". I have a legal background, so I immediately Googled the definition of "Prescribed Minimum Benefits (PMB) is a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. The aim is to provide people with continuous care to improve their health and well-being and to make healthcare more affordable. PMBs are a feature of the Medical Schemes Act, in terms of which medical schemes have to cover the costs related to the diagnosis, treatment and care of:

- any emergency medical condition; - a limited set of 270 medical conditions (defined in the Diagnosis Treatment Pairs); - and- 25 chronic conditions (defined in the Chronic Disease List). I think you will agree with me that all emergency medical conditions were covered (in fact, the first part of the definition expressly says so). Well, rest assured, the devious medical aids have more resolve than that. Apparently to qualify for treatment, they need a valid code, and when they carefully carved out to what extend the spine would be covered by the so-called PMB's, they came to the conclusion that strictly speaking the nerve canal did not continue in your lower back. So in short, if I was fortunate enough to have disintegrated a vertebra in my upper back, I qualified for treatment, but because it is my lower back I do not. Technically speaking, the excruciating pain that keeps me up at night, that prevents me from walking properly, that is causing irreparable damage and that impairs my ability to do my job properly, does not exist. But don't despair, just wait 6 more weeks and on 1 March the waiting period will be over and we will be forced to pay for the procedure????? Does that make sense to you. And of course, all of this is clearly explained to all clients in plain English before they commit? What a total, disgusting travesty.

But wait, there is more. I know Adrienne Gore from when he started Discovery as a normal (hated) ex-Liberty man with nothing, and RMB (actually Laurie, Paul and GT) funded him. He used Momentum (the brand) and called his product Discovery. He hitched a free ride with Momentum Distribution Services to sell his product, and gained from the Momentum experience. I mention this because, you see, before he was untouchable, he too depended on other people to help him. So I thought that if I go to their multi billion dollars extravaganza of a head-office, I might encounter one human being with something called compassion, someone who would at least objectively look at the facts and come to the conclusion that all of this was a lose-lose process. Ultimately (in 6 weeks) they will have to pay, until then I will suffer, and it could even cause irreparable damage. What exactly is the point, other than to make a point. Well, believe me, spare yourself the trouble. The "normal people" really tried to assist, but it was obvious they are not empowered at all. Finally I asked if I could see Adrienne (God forbid, me a mere mortal). After waiting a really long time, I was handed a phone and told it was from "Adrienne's office". A woman identified herself as the person who does this kind of thing (whatever that means, kind of sounds like it happens all the time) and in a monotone explained to me that the process is the process, and I must be quiet and accept it. No emotion, no regard for logic, no compassion.

My mother always referred to some or other poem "lives there a man with soul so dead, who never to himself hath said "this is my own, my native land". Can any company get to the point where profits are so important that they allow their souls to die?

OK, so let me get to the point. Why do I publish this real story? I hate injustice, and I am very certain that many other people have or had a similar experience. I want to please hear from you, because if we join forces, I am sure we can raise our whisper to a level where the untouchables can start to take notice.