Discovery Health Retracts Authorisation after Surgical Procedure

Good Day

I write to seek your assistance following the unsatisfactory and unfair treatment from Discovery Health Medical Scheme

I joined the scheme in November 2024 and selected a hospital plan as we are a young family and do not have day-to-day health needs

On the 02nd February 2026, Monday morning at approximately 1 am I was rushed into casualty following severe pain in my back and legs. I was treated in hospital at the Johannesburg Surgical Unit by a casualty Dr who also took various bloods and administered pain medication. I was then asked for my membership details and shortly after, I was provided with authorisation for admission ( - authorisation number: ***3)

On Monday morning 02nd February 2026, I was taken in for an MRI & X-Ray in order to establish the diagnosis in preparation for a treatment plan

Shortly after, I received a notification from the hospitals radiology department stating that the medical aid has rejected the claim for both MRI & X-Rays - this was performed in an emergency situation and in hospital yet the claim was rejected

On Tuesday morning 03rd February, I was prepared for theatre to conduct nerve blocks, epidural and facet blocks by a Neurologist. The procedure was done under general anaesthetic and I was taken back to my ward after the procedure. I was then attended to by the physiologist to ensure mobility, I was then discharged later at approximately 4pm

Today on the 04th February, I received a letter from Discovery stating that they have reviewed their decision of the initial approval and authorisation for admission and regret to inform me that my claim for funding was rejected

I find this extremely unfair as they have firstly provided authorisation and then retract it after. I do not have the financial means to cover these hospital bills nor surgeons accounts. I also have GAP cover but they will only cover the shortfalls not fully covered by the medical aid. In this case, my gap cover will not even provide benefits as the main account is not been attended to at all

I took out a hospital plan on the basis that it covers medical expenses incurred in hospital. This was not a planned procedure as I was taken into casualty following severe pain - this is not an accidental plan, it’s a hospital plan and therefore benefits should be provided for in-hospital treatment/s

All my treatments were performed and administered in hospital following an admission which Discovery approved and then later decided to reverse the decision after the procedure was done. This is unacceptable and not in the best interest of treating customers fairly

Please step in and help me as I’ve been contributing and paying these premiums over 15 months and in excess of R135,000 - now when I need my benefits to kick in and provide financial assistance, this is the way Discovery Health treats their customers

I’m still awaiting the hospital account and Drs Bills for the Neurologist & Anaesthetist

I’m writing to the council of medical schemes to help me find resolution to this matter.

Thanking you