Discovery Health way of doing their business."You be the judge!!!!"

MY spouse was referred to a Dr for a hip replacement At the time she had a umbillical wound scar from a previous operation many years back. Dr referred my spouse to a plastic surgeon for an opinion before the operation could take place.The was in November 2019.

We visited the plastic surgeon. He submitted a report to Discovery in motivating the procedure required to fix the umbillical wound scar for it to heal properly as this wound tend to open up from time to time .The Dr motivated the procedure in it not being plastic surgery that needs to be carried out but due to the complexity of the wound, the correct procedure to be carried out.( Att 1.Motivation). (Att 1.1.Umbillical wound photo's before surgery)

This procedure and operation to be carried out by the plastic surgeon was rejected by Discovery .We were referred therafter to a general surgeon by our Orthopedic Dr. The surgeon submitted the codes for the procedures to be carried out. The operation, admission and hospital costs was approved ( Att 2.Discovery authorisation document.).Authorisation number ***4

The operation was carried out on 27January 2020.My spouse was dismissed from hospital a few hours later. On returing to the Surgeons consulting room to have the stiches removed, the wound flared open immediately as the stitches were getting taken out. The surgeon himself commented that the wound now two weeks later does appear to be septic and worse (Att 3.Photo of the septic wound) My spouse was referred by the surgeon to for wound care amidst Covid 19 break out. Vita Nova in Brits did an exceptional job in getting the septic wound to heal properly. To date Discovery did not pay Vita Nova for services rendered.

I exhausted all the Discovery avenues to resolve the matter in getting Discovery to pay Vita Nova as the septic wound was not our fault at all.

I phoned customer services a thousand times. I visited Discovery Head Office in Sandton and was refused entrance to see a consultant. I then loged a dispute and filed a report. I therafter couriered the documentation to Discovery's legal department in Cape Town as I was told to do so and handed in a copy a Discovery Head office dispatch.(att 4.Dispute)

No response and no feedback for a very long time . On 9 September 2020, I received an e mail on on 23 July 2020 now suddenly stating that Discovery are now declining funding for the reason of benefit criteria now suddenly not being met.(att 5) The procedure was approved by Discovery to pay for everything in full before the operation commenced. Authorization number ***4..At the time we were on Classic Comprehensive and our membership was paid up in full.What a laughable matter

Various attempts from Vita Nova,motivations from the surgeon and radiology reports,only excuses from Discovery 's side in avoiding their responsability to pay of Vita Nova..We had to stop treatment as we could not afford to pay Vita it from our own pockets.The wound deteriorated going backward to being septic

During the" Force mayeur " declared by the Sa Goverment of Covid 19,my employer reduced our salaries to 40%. I had no option as to lower our plan from Classic Comprehensive to that of a Discovery Hospital plan. All of this happened in July 2020, and was not applicable at the time of the surgery and wound care.(Att 5).Vita Nova's corresponence with Discovery).Pictures of wound debrimendt progress during wound care.(Att 5.1-5.6)

All of the requested reports by the doctor and radiological information was again forwarded to Discovery, but only smart footsteps from Discovery in paying for what we were entitled to in terms of my spouse receiving treatment for a septic wound

This id how Discovery treat its patients and fulfilling their obligations.May I say that their service levels are pathetic.Their timing and correspondence and feedback letters proofs my statement.

On 16 November 2020 I received a letter from Discovery,(att 8),stating that they,Discovery acknowledges my actions in logging a dispute.The answer in summary was that Discovery agrees to pay a portion of my spouses hospital admission and acknowledged that the wound complications is deemed a PMB and as such Discovery Health are egually obliged to pay for the wound care up to standard level of care. This was in November 2020,nine months later???.To date ,no payment to Vita Nova and no further correspondeve received .(Att 9 .Letter from Discovery)

I logged a formal dispute with Discovery and send the documentation to the Discovery legal department in Cape town.(Att 7 ,Dispute documentation submitted ) and (Att1a ,Postnet certified mail slip)

After downgrading our fund after being a member of the Classic Comprehensive plan with Discovery for 21 years, I received a invoice for monies due to Discovery as a "clawback" for having to downgrade on the health plan for valid reasons mentioned for the amount of R 26 335,06.

I responded to Discovery in a letter in saying that it is with regret that I have to inform them that due to the Force Mayeur and its concequences, simply cannot pay them whereas in normal circumstances there was no intention to downgrade on our health plan

As we enter the new year, I upgraded my plan from a hospital plan to that of an entry level plan with a 14000 savings account as my spouse needs medical attention as we got nowhere in visiting Groenkloof Hospital during Covid with my wife felling ill.We are now 20 weeks down the road and my spouse are still very ill.

My wife had a desmoid tumor removed 25 years ago In visiting an emergency unit to see a doctor for an opinion and possible hospitalisation for the Hospital plan to take care of things,nothing came of that.My wife does not stop coughing and we are afraid that the tumor might be active again in irritating the throught area leaving her with intensive coughing for 20 weeks now.The ER unit carried out a X ray and did a blood test.You will not see any tumor activity if that could be the cause with an X ray.Needless to say, if your life is not hanging on a tread,don't waste your time and money to go to a ER when you have a hospital plan and have an emergency.

In upgrading to a minimum hospital savings plan in 2021,at least we thought that this will help us in case of an emergency as my wive is still sick.Discovery welcomed us onto the new plan with entrance of 1 January 2021 and allocated R 14000 medical savings to the plan

Today we finally visited our GP as to seek medical help for my spouse still not feeling well .In visiting the pharmacy afterwards to collect the prescriptive medicine,I was standing there with a red face as I was told that our savings portion is exhausted and reflecting a zero available funds. All of this without a single letter of notification of any kind of Discovery's intentions to do just that.Discovery took the R 14 000 as down payment on the R26000 outstanding.Two different plans.How is that for being smart.No notification of their intention to do so at all

Here is what you as the public have to consider before you join Discovery;

What is your rights and financial obligation in a Force Mayeur scenario going forward Discovery deciding on what is cosmetic procedures versus the correct procedure that has to be carried out to avoid complications. Have a look at my spouses umbillical appearance as where we are today.What about having to stop the wound care and with a wound appearing worse than before surgery.To top it all we cosulted a Orthopedic surgeon for a hip replacment remember.No hip replacement

Would you agree with me that the procedure should not have been carried out by a general surgeon?Should you not agree with me that the wound and its appearance after surgery is worse? No payment to date to Vita Nove despite a letter in saying that Discovery are legally obliged to do so What about the trauma,scars as the wound now are worse than before.In the midst of Covid 19 ,we had to stop going to Vita Nova due to Discovery not paying and to top it all.

The best is yet to come in terms of Discovery admitting us to the new plan with a R 14000 savings portion for the year.Today I discovered that Discovery cleared the savings portion to a nul balance and took the savings as a down payment on the R 26 000 without even notifying us .

To date Discovery still avoid the dispute loged and no correspondence received.They are not paying Vita Nova an outstanding account of more than R 10 000.How is this fair?

I do not want to be part of such an orginization going further.

Finally if you have "Life Insurance "with Discovery and you downgrade on your health plan your policy premuims goes up.Interesting.How is it possible for two seperate divisins to be linked ?

This is what I want to make the public aware off.They are simply to big and untouchable and not interested to get back to basics and provide good service

All statements,correspondence and foto's are available and I am willing to submit it as proof.

The fat lady hasn't sung the last song but think carefully before you join Discovery in claiming they are number one.It is a lie.You are welcome to lookat the facts and then you be the judge!