Discovery Health refusing to pay for authorised in-hospital Monofer treatment

Discovery Health refusing to pay for pre-authorised in-hospital iron deficiency treatment.

I am extremely disappointed with Discovery Health’s handling of my husband’s recent hospital claim at St George Life Hospital (Port Elizabeth)

My husband was admitted to hospital and received Monofer (intravenous iron) treatment during his stay. The hospital admission and treatment were pre-authorised by Discovery Health prior to the procedure. We need to pay the hospital R5,233.57 for the medication. The reason code we got was: 50022

Despite this pre-authorisation, we have now been informed that Discovery Health is refusing to pay for the Monofer administered while he was admitted. This is both confusing and unacceptable, as we re**** on the approval granted before treatment proceeded.

Pre-authorisation should provide cer*****y and peace of mind, especially in a hospital setting where patients are vulnerable and decisions must be made based on medical necessity, not uncer*****y around payment.

We would like: An urgent review of the claim.

We have always paid our premiums in full and on time, and it is deeply frustrating to face unexpected costs after following the correct authorisation procedures.

We request urgent resolution of this matter.

Some additional information:

### 2. Policy language (Discovery Health Medical‑Aid Benefits Booklet 2023/2024) > **Cover for medicines & related items** – All prescribed medicines, including those administered in‑hospital, are covered up to the Preferred Medicine List (PML) price or the Reference Price, whichever is lower. Items not on the PML may still be covered when a *medical‑necessity* justification is provided. > **Hospital‑supp**** supplements** – The scheme covers any *prescribed nutritional or the****utic supplement* required for the treatment of a diagnosed condition, provided it is prescribed by the attending doctor and the claim is supported by a valid prescription and clinical notes. > **Non‑formulary items – appeals** – If a claim is denied on non‑formulary grounds, the member may submit an appeal with supporting medical evidence (lab results, doctor’s letter) to demonstrate medical necessity.

These clauses (pages 12‑14 of the attached **Plan‑comparison brochure**) make clear that an iron supplement prescribed for a documented deficiency qualifies as a *medically necessary* item and therefore should be payable.