Discovery medical aid is refusing to contribute for operation following vehicle accident.

I am writing this review based on our experience with Discovery medical aid following my family members motorcycle accident. My Nephew is on Discovery Keycare Plus scheme. Since he is quite young and in good health we felt that it is prudent that he have a medical aid for the unforeseen events ( like car accidents) where he might end up in hospital. Keycare plus seems to cater for that ("Unlimited hospital cover") we chose that option and have been happy with that until we tried to use it.

On the day of the accident ( a Sunday) we took my nephew to an approved hospital emergency room. X rays were taken of the injured knee, but due to the extensive swelling they could not see much. an MRI was needed. Discovery refused the MRI costs. Fine: we paid the R8 000 for that. Because the MRI machine would only be available a week later the doctor sent him home with a brace. after the MRI the specialist recommended surgery to correct the issue and this is where the real trouble began. We could not get him admitted into hospital to have the operation because this requires pre-approval. But this does not get pre-approved because it is not on the list of paid for medical issues. But this is not medical ( such as heart conditions or such ailments) this is a result of Trauma, a motorcycle accident. we were told that discovery does not pay for knee or shoulder operations. So even though "Trauma" is 100% covered, even though hospital is 100% covered - his knee cannot be operated on. he was a normal 25 year old 4 weeks ago, but now he cannot walk. We were also told that the "trauma" definition as mentioned on the website does not mean the same as "Trauma" in the dictionary. apparently discovery has re-invented the work "Trauma" to only mean loss of an organ. Dictionaries define it as a physical injury (as opposed to disease). interestingly we can't find a list of definitions from discovery that includes that definition.

How can "Trauma" be covered by this plan ( no matter the definition) if the operations to fix it are not on the list either? The list of approved operations are clearly communicated and indeed, knee operations are not on it. Neither is stitches for a cut. Neither is a cast for a broken bone, or anything else that might be needed if one is in a car accident.

After this we used the Discovery internal mechanisms to raise a dispute, to no avail. every single doctor we have spoken to has been surprised and disgusted that the medical aid has refused to honor this claim, so we intent to take it further to the medical aid board.

I would therefore like to strongly advise anyone who think they might one day need a medical aid not to consider Discovery as they don't assist you if you are in a car accident.