Discovery Health Refusing to Pay My Emergency Claims

I’m sharing this because I believe Discovery Limited needs to urgently review my case and take accountability for the medical claims that were rejected.

I was recently rushed to hospital and submitted my medical claims to Discovery Limited , only to be informed that the claims would not be covered because ER without admission apparently is not covered under my plan.

This came as a shock to me because I was never provided with this exclusion in my offer letter or documentation when I joined. Had I been made aware that emergency treatment was excluded from my cover, I would have been in a position to make an informed decision about my medical aid and understand the financial implications.

I therefore requested the recording of the call from when I joined, so that I can establish exactly what was communicated to me regarding my cover and exclusions.

It has now been a week since I requested the recording, and despite following up with Jade, a Team Leader, I still have not received it.

At this point, I am not simply looking for an explanation. I want Discovery Limited to properly investigate my case and reconsider the rejected claims. I expect my claims to be paid if this exclusion was not clearly disclosed to me when I signed up.

I am therefore requesting that Discovery Limited :

• Provide me with the requested call recording without further delay. • Clarify exactly where and when I was informed that emergency treatment was excluded from my cover. • Review the rejection of my claims in light of what was actually communicated to me when I joined. • Reconsider and pay my outstanding claims if this exclusion was not properly disclosed. • Place my medical aid premiums on hold while this dispute is being investigated and resolved, so that no further premiums are deducted from me during this period.