Discovery is refusing pay for an ER visit that qualifies as PMB

Hi. I'm on Classic Smart. My kids and I were exposed to smoke inhalation in the wee hours of 25 February 2025 when a fire broke out in our home while we were sleeping. By God's grace the dense smoke woke me up and I managed to wake my 7 year old to hold my 15 month boy by the opened window whilst I figured out how to get us out of the house. My partner took us to the ER as we were coughing with tight chest where we were examined and had X-Rays done as well as had nebulizers administered. On 26 February 2025 I got a call from Lake, Smit & Partners and was informed that Discovery rejected the R1800 claim for X-rays and I need to settle the account. When I call Discovery, they informed since we were not admitted, I need to settle the account as my plan does not have medical savings. That'll mean everything else that related to the ER visit will have to be paid out of pocket which in total is R6813.84 as all claims related to this traumatizing visit have been rejected. I'm utterly disgusted by Discovery's conduct. The attending doctor used code J68.2 which the nature of the incident falls under but I'm told I have to apply for out-of-hospital Prescribed Minimum Benefits that is subject to review and they request Radiology reports as well as Casualty reports for the visit.

It is ridiculous that something as serious as this, is not covered under their Prescribed Minimum Benefits. The male consultant I spoke to yesterday told me that since all our tests, exams etc. came back normal, this won't be covered under PMB. Where in the actual world does this make sense? So we should have been harmed in order for Discovery to pay for the ER visit?

I have medical aid and my kids and I had a case that qualifies as an emergency but I am told I should have used a network GP. Which GP is opened at midnight? Emergency conditions fall into a special category and should be treated anywhere with coverage. Hospital admission is not a requirement for a medical emergency to be funded from PMB. Diagnostic Treatment Pairs is there for a reason.

I went to my work's nurse for an examination yesterday after experiencing sharp pains on my chest and I was told my chest sounds like that of someone with asthma and I can't even think of medically consulting further as I will have to be at death's door in order for Discovery to pay for my treatment. Utterly nauseating!

I cannot believe that on top of the mental toll stemming from the fire outbreak at my home, I have to also deal with this financial abuse that Discovery is subjecting me to.