Discovery does not cover you fully in hospital in case of an emergency

Do not be fooled by Discovery Health when they say you have full hospital cover in case of an emergency. In July of this year, I was rushed to the ER at Pretoria East hospital with sever pelvic pain. I was diagnosed with a burst cyst (5cm in size), and internal bleeding. The situation was an emergency and I needed to have an operation straight away, for repairs and to stop the bleed. My life was in danger. I was in no state to handle the pre-authorisation, so the hospital had to do it on my behalf. I was informed that Discovery would pay everything in full. I had lost one litre of blood by the time the operation was done. Imagine my surprise when I received a bill from the hospital for R7950. Apparently, if the surgery, that was performed to save your life, is done laparoscopically, there is a deductible of R7950 regardless of whether or not it was an emergency. When I investigated, I found that the hospital bill was paid in full but then this amount was reversed. It has been 4 months of back an forth between the hospital, my doctor and discovery to try to resolve this issue. I am on the Classic Priority plan which states the following: "In terms of the Medical Schemes Act of 1998 (Act No. 131 of 1998) and its Regulations, all medical schemes have to cover the costs related to the diagnosis, treatment and care of: - An emergency medical condition" Discovery's definition of an emergency: "An emergency medical condition, also referred to as an emergency, is the sudden and unexpected onset of a health condition that requires immediate medical and surgical treatment. Failure to provide medical or surgical treatment would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part or would place the person’s life in serious jeopardy. An emergency does not necessarily require a hospital admission. We may ask you or your treating provider for additional information to confirm the emergency." I have a letter from my doctor stating that the surgery was an emergency but Discovery still won't pay because there is some or other code that needs to be on this letter that indicates that my life was in danger. My doctor cannot understand why Discovery won't pay because they used all the codes they usually use, including an emergency code. So I am left with resolving this issue. In the meantime Pretoria East Hospital is on the verge of handing me over for this outstanding amount. So please, be warned when considering Discovery as a medical aid. It seems they are not what they say they are.