Discovery is not a medical aid

My son broke his wrist on 20 July. It was so badly displaced and deformed that this was not a routine injury. He needed emergency treatment, X-rays, an orthopaedic surgeon to manipulate and straighten the fracture, an anaesthetist to sedate him, theatre-related consumables and follow-up treatment.

When you look at the Prescribed Minimum Benefit (PMB) provisions, this type of fracture and the necessary treatment fall within the scope of PMB cover.

Yet dealing with Discovery has been an exhausting process of delays, repeated questions and incomplete payments.

After I pushed the matter, Discovery eventually acknowledged that the condition qualifies as a PMB and approved cover. But even then, the authorisation period they provided did not properly correspond with the treatment dates, and a substantial portion of the related accounts remains unpaid.

I complained again. Instead of simply resolving the outstanding PMB claims, the process continues: more questions, more delays and more administration.

This is exactly why consumers need to understand their PMB rights and challenge decisions when something does not make sense. Most people simply do not have the time or energy to keep fighting a medical scheme while also dealing with an injured child.

Medical schemes have legal obligations when it comes to Prescribed Minimum Benefits. Patients should not have to fight for months to receive benefits that have already been acknowledged and approved.

My advice: keep every document, get everything in writing, understand your PMB rights and don't give up simply because the process becomes difficult.

I intend to take this as far as necessary until every legitimate PMB-related account arising from my son's injury has been properly dealt with.