Discovery bad service

In hospital procedure with discovery authorization code, most of the claim not paid , reason out of medical aid rates . website clearly states in hospital cover @ 200% the claims that are paid out only done at 100%, reason. This is with motivation letter for surgery but NO always a reason not to pay, when escalating the situation get a reply that if I have GAP COVER then it could pay, so I must pay and pay and pay? Now i must go to the medical ombudsman as per Discovery if I am not satisfied.