Discovery Emergency Unit does not exist - refuses payment for small child’s emergency

On the evening of the 11th June 2018 my child (2 years old) was vomiting. We rushed over to our NETWORK hospital emergency unit to seek medical assistance as all other doctors were closed. Hospital emergency unit was our only option. So I rushed all the way past 3 other Hospitals to come to the "NETWORK" hospital. I have since, to my utter astonishment, received a statement to say that I am liable for the payment. If its of any value to know; the doctor wanted to admit him for dehydration but assured us that the treatment he gave should help him feel better. He said that the baby would however feel more comfortable at home but said we were to come back if he continues to not retain fluids. So we took our child home. And true as Bob, our child did feel better thanks to the treatment he received.

But I cannot for the life of me understand where this bill comes from, and why Discovery is ambiguous in terms of "NETWORK" providers.

Not even my broker could understand the reason and he said “I find it strange that you received that message, as I am under the impression that Ferncrest is a provider. (attaches screenshot of system as proof) I will escalate to Health for clarity.”.

The response finally came through (signed with a meaningless "Regards") was as follows: “According to the Smart Plan benefit information, Netcare Ferncrest Hospital ********** is a Smart Network hospital; Dr Grunewald ********** (the only available Emergency Unit might I add) is a GP practice, they are not a Smart Network GP”. Basically they are saying that the Dr or Emergency Unit at Ferncrest is not a Smart Network but the Hospital is.

Huh? Firstly - is this statement sent to me in error? Discovery did not specify where I should take my dying child other than to say Ferncrest is a Network Provider. Secondly - I am not comfortable being held liable for this payment. Discovery should ensure that the network providers have network doctors to help their clients. I cant be held liable for mismanagement and unstructured systems that were meant to be set in place by discovery. I cannot be expected to deny my child health services while I first confirm if the doctor at the Network Hospital is indeed also a Network Practitioner. Thirdly - Are there any other matters that need to be disclosed to me that are not blatantly obvious? Just in case I am to first confirm through 50 pages of Terms and Conditions of Cover when faced with an emergency. (Yes dear reader, a small child with a Fever and symptoms of dehydration is NOT considered an Emergency by Discovery health).

On that note, someone at discovery needs to please clarify what the following means: taken directly from my Health Plan Guide “EMERGENCIES ARE COVERED IN FULL – If you have an emergency you can go straight to the hospital” Yeah right… That’s what I did and here I am.

Then, to top up the insult to injury, Discovery makes ME ask the doctors to motivate as to why a dehydrating child is considered an Emergency. It’s not bad enough that they deny cover, I must now be a Discovery agent and supply endless paperwork and emails. But, you guessed it, they still denied cover.

In the end after threatening to throw away all my Discovery Products (we talking near diamond vitality status, credit cards, annuities, life insurance, short term insurance – this stupid customer has it all) they let me apply to have it approved as my PMB (Prescribed Minimum Benefit). Again I asked and pleaded for the doctors to write reasons as to why I should be covered and in the end IT WAS STILL DENIED. By the way doctors don’t care about this. They don’t remember you or what they said. The sloppy motivation was from a random doctor who didn’t even help my child because the original one is unavailable only wrote “please reconsider”.

So then; the ORIGINAL reason for denying cover was because it was out of network hospital. WHERE IS THE NETWORK HOSPITAL SHOULD I ENCOUNTER ANOTHER EMERGENCY? As I understand there is no network emergency unit as discovery does not have this agreement with the emergency unit. Do yourself a favor and phone Ferncrest and find out what is going on. Ferncrest DOES NOT HAVE AN EMERGENCY UNIT!!!? How can Discovery say Ferncrest is a network hospital and then in the same sentence say the emergency unit is not covered? DOES A NETWORK EMERGENCY UNIT EXIST?

Also: please explain what an emergency is. This was the second sloppy excuse for not covering. Does Discovery Health not recognize that a small child can much more quickly become dehydrated that an older person?

So here I am. I still don’t know where I can obtain this ELUSIVE Network Cover – it seems as though I am only allowed to have an emergency at certain times of certain days of the week. And it would further seem that |Discovery is heartless, if your child didn’t die in the process of seeking medical assistance for fever and dehydration then you are not covered.