Discovery look for reasons not to pay

<p>I wish every South African could read this.</p> <p>My son who's studying at University, turned 21 last year. I had to move him from our Comprehensive Medical Plan to a more affordable plan and put him on Keycare Plus due to the fact that Discovery views him as an adult and not a dependant while he's studying and still under my care.</p> <p>A few months later, Discovery more than doubled the premiums which forced me to move him to Keycare Hospital Cover only.</p> <p>A month ago, my son had a motorcycle accident and went to casualty with a knee injury. Fortunately, there were no breaks, only soft tissue damage. </p> <p>We had to pay the x-ray and Doctors accounts, physiothe******, then the crutches and knee brace.</p> <p>His knee join remained painful and he couldn't straighten his leg nor bend it fully.</p> <p>After his mid-year exams, he came home on vac and we sent him to another Physiothe****** - who then recommended that he go to an Orthopaedic Specialist. </p> <p>This we did... all at our cost.</p> <p>The Orthopaedic Specialist recommended surgery </p> <p>I contacted Discovery for Authentication. </p> <p>This is when they started finding excuses. </p> <p>Firstly, we needed to be referred to Specialist by a GP.</p> <p>Then Discovery rejected the surgery because the hospital where the Specialist wanted to do the op, wasn't an approved Keycare Hospital. </p> <p>They rejected the Orthopaedic Specialist because she wasn't a Keycare Specialist. </p> <p>Then they rejected the procedure (Arthoscopy) wasn't covered in the Keycare Hospital Cover.</p> <p>Then they rejected everything because 'all knee operations' are not covered in this Keycare Hospital Plan (as well as all spine and sholders - to mention what they said)</p> <p>They said we could either get the Specialist to motivate the procedure (decision up to 3 days later) but it would still excluded the Arthoscopy - in other words, the op needed to be an open surgery. The risk of it being rejected was high because it was a knee op that wasn't covered in the Keycare Plan.</p> <p>They also said we could take him into Casulty at the Keycare hospital and then he'd be referred to a Keycare Specialist who'd assess and then we'd be hopefully be able to sort his knee out.</p> <p>We did this - spending more than 6 hours in Casualty .</p> <p>The Keycare Casulty Doctor on duty examined my son and then referred us to a Keycare Orthopaedic Specialist. </p> <p>We had new x-rays taken. The x-rays confirmed no fractures and said there were a few things wrong and an MRI was recommended. </p> <p>Casulty then tried to get Hospital Authorization from Discovery and this was rejected because it was a knee injury. (not covered by the Keycare Plan)</p> <p>The Keycare Orthopaedic Specialist told us that this injury was a Prescribed Minimum Benefit (PMB) amd all Medical Aids were obliged to cover it.</p> <p>My son cannot walk nor put any weight on his leg.</p> <p>The Casualty GP told us that Discovery Keycare Hospital Plan had the worst reputation while Fed health had the best Hospital Plan.</p> <p>So, a motivation later was now needed by Discovery from the Specialist. </p> <p>We made an appointment with the Keycare Orthopaedic Specialist and he used a sonar to inspect the knee in more detail. </p> <p>He wrote a motivational letter to get the MRI done.</p> <p>We went back to the X-Ray Division and they have to request authorisation for the MRI sending the motivation letter to them.</p> <p>Then we were told by the X-ray Department the Discovery needed the the Specialist referral number (GP referring us to a Specialist ) for themto approve the MRI.</p> <p>Only the Casulty GP could do this as he needed to fill out a form and submit it to Discovery. </p> <p> </p> <p>The Keycare Orthopaedic Specialist remarked that the open surgery was so outdated, he didn't know a Specialist that even performed this op with open surgery. </p> <p> </p> <p>My son needs to return to University next Friday and we would have hoped to have had this problem sorted out during his vacation - which is not going to happen </p> <p> </p> <p>My advice to all - choose wisely</p> <p>Don't read the marketing ******* that these companies use to try and sell you ****, disguised as roses.</p> <p> </p>