Discovery Health Hospital Plan

Discovery Health's claims payment policies is ********* and *********. They offer and advertise that all their Medical Scheme plans offer unlimited hospital cover. They assure their members that hospital cover includes the account from the hospital as well as the accounts from your admitting doctor, anaesthetist and any other approved healthcare professional(s). However, in practice, they refuse to pay the admitting doctor's bill if you're not immediately admitted to hospital the very same day, which is nearly impossible. We all know that there are a lot of arrangements to be made for a planned hospital visit, eg. You need to get pre-authorisation, it has to be an "approved" hospital for your specific health plan, and to complicate things even more, the procedure needs to be done on a specific roster that suits the hospital, theatre and the doctor. Yet, Discovery Health has structured their claims procedures in such a way that they refuse to pay the admitting medical practitioner's bill if you are not hospitalised on the very same day as the consultation.

To add insult to injury, (in our case) did they not only process the approval for the wrong member, it took them 4x days to correct their mistake and provide us with a valid pre-authorisation number which nearly caused us having to reschedule a very urgent procedure.