Discovery Health Emergency Care

Discovery Health Members need to be made aware that Discovery has adopted a policy / modus operandi of 'limiting' their risk exposure by using lists of ‘emergency diagnoses’ and implementing various procedures that are very narrowly constructed in order to avoid payment. Discovery refuses to pay the emergency room bills if the medical practitioner manages to efficiently treat the condition and the patient is subsequently discharged instead of being admitted to hospital. According to Discovery Health, it is not an "emergency" if you're not admitted to hospital, or if the doctor uses a different ICD-10 code from what is on their "list" of qualifying "emergency" procedures.

The rest of the world and the whole medical profession considers a medical emergency as “the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity" - such that the absence of immediate/urgent medical attention could reasonably be expected to result in: placing the patient’s health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part. Patients generally do not have the knowledge to self-diagnose or treat their condition, nor can the layman distinguish the symptoms of a serious illness from the symptoms of less serious problems. Isn't that why we need emergency care after hours?