Discovery health scheme ***** and *******

On the 25th of March I was in labour and booked for an emergency cesarian section for the birth of my daughter. My delivery date was 2 weeks ahead of my estimated due date.

I had already completed my pre-authorisation where I was asked if I was electing to have a c/section and I explained that although, with my first child I ended up having an emergency c/s, my doctor had assured me that the chance of this complication was minimal and that I had a good chance of having a natural birth, so "no I will be having a natural birth, should everything go well. The operator/call canter agent proceeded to book me in for an elective c/s. This mishap, resulted in a slew of problems for me:

1) Discovery did not pay for my medical bill (gynae and anasthethic) as they state that the providers are "above medical aid rates" - when I dispute this, I am told that because I had "elected" a c/s, it was then my obligation to get providers that are in rates. - approximately R12 000 for my gynae and R6500 for anasthesiologist. 2) I explained the facts of the case and eventually asked that Discovery provide me with the recorded version of my call, so I can prove that this was a fault of their own- upon such request, I was then advised (by their agents) that a better and sufficient method of solving my problem was to have my doctor write a letter explaining the medical facts of my delivery and what caused the emergency. I did that and they still refused to pay out, with no real explanation. 3) I followed up again, this time demanding my recording and again being sent from pillar to post, until being told that they would request it but could not commit on when the said recording would be provided - it is now over two months and they are not willing to send it.

In the interim, I have been blacklisted by the anaesthesiologist and handed over to an attorney by my gynae.

4) My daughter was admitted into hospital (after receiving the pre-authorisation) on the 23rd of October 2019. This is part of the benefits to be covered by medical aid. Discovery did not pay for a sum of approximately R4000. Upon following up, I was told that the medical scheme has an agreement with the hospital (Netcare Parklane), to not pay for "half days." I was then informed that because I had been admitted/discharged 30 minutes before or after midday, they would not pay for the stay and medicines administered and doctors check for that day.

There is no where in my contract where such a loophole is stated, nor did they request such information to be communicated by the hospital. However, it is a detail they tell me after the fact- as though I am in control of when I get discharged. In the letter sent to stating all the things I should know about my holiday stay, has no such information/ clause.

I warn everyone against this scheme as they ***** and cheat people of their money. Even when given the opportunity to prove themselves right, their shocking customer service and untrained call centre agents, send you from pillar to post without any real assistance.

I am still wanting my recording as is promised upon calling: "...should you require a copy of your call will be made available to you." BLATANT LIES.