Discovery Health - Refusal to Pay

On September 7th, 2023, I felt unwell and tight-chested during the day, attributing it to exhaustion and seasonal changes as I had been experiencing similar symptoms for the past two weeks. Later in the evening, around 15h30, I experienced difficulty breathing to the extent that I was grasping for breath while walking or doing simple tasks.

I was rushed to Umhlanga Hospital, where it was discovered that I was in dire need of oxygen. I was immediately taken to a bed in the outpatient unit and administered with oxygen. My vital statistics, particularly oxygen saturation, were dropping, requiring continuous administration of oxygen. This lasted for more than a few hours. The doctor decided I needed to be admitted due to the severity of my condition. Please note that this was neither anticipated nor a pre-existing condition; it was unforeseen and unexpected.

The date of joining Discovery Health Medical Aid, indicated on my Certificate of Membership is "2023/09/01." This date clearly appears on my Certificate of Membership as the: "Original date you joined," "Certificate date," and "Effective date." One would interpret this, as I have done so, that the medical aid can be utilized from the said date mentioned. Please note that I had no intention of purposefully utilising this medical aid unless there was cause to do so.

The Certificate of Membership does not reflect a waiting period. I have had conflicting conversations and communication, where Discovery Health initially stated verbally that there was a 3 (three) month waiting period, later changing it to 12 (twelve) months.

Discovery Health's Underwriting Policies and Protocols 2023, Page 3,, clearly state: "We may apply 12-month condition-specific waiting periods." The operative word is "may," indicating a “possibility” as defined in the Oxford Dictionary. Discovery Health cannot automatically apply a waiting period because a medical situation has arisen. Furthermore, Discovery Health insists that the waiting period was communicated to me which is untrue. Despite numerous requests for evidence, such as recorded conversations or signed documents, Discovery Health has failed to provide any. I was never informed of this in any form or manner. Had I been aware, I would have sought medical assistance from another facility to avoid financial predicaments.

Discovery Health attributes their non-payment for hospital admission and bills to my hospitalisation which occurred shortly after my membership confirmation. However, the Personal Medical Assessments (PMA) from the attending doctor and the ER Consulting Report explained my respiratory condition, impossible to have been preempted or planned.

We submitted an Appeal and Motivation to Discovery Health on September 19, 2023 followed by letters on September 21, 2023, and October 3, 2023. Our correspondence was ignored, prompting another email on November 10, 2023 We then received a letter from Discovery Health stating a 12 (twelve) month waiting period

The assertion of a waiting period is unfounded, and I find it ********* that Discovery Health imposes such conditions, given the absence of any waiting period stated on my Certificate of Membership or communicated to me. I feel extremely prejudiced by Discovery Health in respect of their change of decisions in terms of the waiting period that they chose to impose on me, hence resulting in their nonpayment of my hospitalization. It is evident that they are biased in their decision, and I believe their grounds to do so are non-founded.

I did consult with other medical practitioners and was told that Discovery Health is privately owned hence they try to find every excuse not to pay a members benefit.

I believe a fair outcome would be for Discovery Health to overturn their sanction in refusing to pay for my admission bills.

People need to know so I am posting here, but I am prepared to pay for a public article in the newspaper and for social medial to inform people of this situation if Discovery Health does not pay up.

I am sure there are many experiencing the same problems with their non-payment as I am.

They keep saying they will get back to me but they don't ever.