DISCOVERY DOESN'T CARE

After being forced to go up and down to the hospital for three consecutive days while in a severely ill condition, I was finally admitted to Garden City Hospital – not through the casualty unit, but only after securing a referral to a specialist from my general practitioner. At the time of admission, my kidney function was critically low at only 5%. I required urgent treatment, including dialysis and chemotherapy, and remained hospitalized for a considerable period.

It is deeply concerning and unacceptable that I was initially denied admission through casualty, despite the attending casualty doctor believing I required hospitalisation. This decision was made by a Discovery representative working onsite at Garden City Hospital – a woman named Gwen or Gale. It appears she is positioned there not to assist patients, but to actively block necessary admissions, regardless of medical urgency.

I am extremely disappointed and disgusted by Discovery's conduct. For a medical aid scheme that consistently collects monthly contributions, this kind of treatment in a life-threatening emergency is not only *********, but also appears to be a violation of my rights as a medical aid member and a patient.

If I had not taken the initiative to see my GP and secure a referral, I could have experienced total kidney failure or even died. Your denial of admission delayed urgent care and placed my life at risk.

To make matters worse, I am now receiving outstanding medical bills for services and treatments that were essential during my stay – including:

Blood tests conducted by Ampath, and

A catheter that was medically necessary during hospitalization.

These bills remain unpaid by Discovery, despite the fact that they relate directly to my in-hospital care for a life-threatening condition.

My Rights and Legal Standing According to the Medical Schemes Act (No. 131 of 1998), as a member of a registered medical scheme, I have the right to:

Receive the prescribed minimum benefits (PMBs) for emergency conditions – kidney failure falls under these benefits.

Not be denied access to emergency treatment, as defined by the Council for Medical Schemes.

Appeal and escalate claims and complaints, and receive proper communication and resolution from the scheme.

What happened in my case may constitute a breach of these rights, particularly the denial of emergency care and the non-payment of PMB-related services.

Action and Intention to Escalate I submitted a formal complaint previously, and the only response I have received was a generic letter indicating that my claim and admission will be reviewed. To date, there has been no meaningful feedback or resolution.

Given the gravity of this issue, I will now be escalating this matter to the Council for Medical Schemes and pursuing legal consultation, if necessary. I believe this case warrants an independent investigation into the conduct of Discovery and its representatives, particularly those interfering with medical decisions at point-of-care.

I request a formal written response within 7 working days, detailing:

Why my admission through casualty was blocked,

Why Discovery refuses to cover medically necessary in-hospital treatments,

And what steps are being taken to resolve this matter.

Failure to respond satisfactorily will result in further formal action.