Discovery admission refusal

On Saturday the 9th of March, I ended up breaking part of my hand- the 5th metacarpal which is the bone below the pinky. This exact bone had been broken previously in 2015 where they inserted a small plate and *****s, at this time I was with discovery.

I had to go off discovery but rejoined them in November 2018. I listed all issues that I had and received 12 month waiting periods on them as well as the general 3 month waiting period.

I went to see an orthopedic surgeon on Monday the 11th of March and was told I definitely need an operation to fix the bone and plate which had bent. Obviously a must procedure to fix my dominant hand, seem as immoderate to avoid permanent displacement and because of all the pain.

I called authorizations and was told that it would take 8-16 working hours for a decision as it needs to go to the “standards” board. I got a call at around 4pm on Monday to tell me that the authorization is being declined because I did not disclose the information and I basically **** to them.

I tried to look on the form where I did not disclose this because all I could remember was a question about surgery in the last 12 months. I eventually found ONE word that stated fractures (number 20) in a sentence/ question of 21 other serious conditions like lupus and ankylosing spondylitis.

I was in no way intentionally being untruthful, and mentioned other conditions!

The orthopedic surgeon said that this new event was in no way connected to the previous fracture and in fact the plate that was in there makes it stronger. I was just very unfortunate. I will get this in writing if needed. Therefore I see discovery just using a previous event with no relation to this as a loop hole to not pay for my procedure.

I have used every single cent I have, maxed out every card I have and borrowed from a friend to pay the R61 749 for my operation yesterday. I have nothing left. I insisted on coming home after the surgery as I could not afford to pay to stay over night and am currently trying to deal with pain management at home.

This is how the biggest medical company in South Africa treats its clients.

I will be taking the necessary procedures to get to the ombudsman and would like discovery to start the process. I just believe that these stories need to be in the public eye which is why I have started here.

Please advise