1 reviews | Active since Nov 2013
Discovery needs to meet their client's needs!
Discovery Health rejected a recent request to pay for my breast reduction, which I have since paid for myself. At a cost R45 000 (and about R3000 afterwards for things like lab tests on the tissue removed, medication, overnight stay), I expected them to at least pay for the R5000 anesthesiologist, the R1050 for overnight stay and the R350 or so in medication and bandages afterwards. Keep in mind that at the time I had about R6000 in my savings.<br> The reason for my breast reduction was not cosmetic, but since I had pain in my back especially when I try to exercise, I saw it as the only solution to my gradual weight gain and better quality of life.<br> One would think a medical aid claiming to want people to be healthy and fit would at least look each case individually.<br> Well Discovery, you will be happy to know that I am looking forward to being able to exercise and stay fit after I've made a full recovery in a few weeks.<br> About 5 years ago I had lasik eye surgery, which Discovery also refused to cover and I paid the R18g myself. The lasik eliminated the need for glasses, meaning no claim from medical aid for eye tests, glasses since. <br> I will be looking into a new medical aid come January.
Thank you for your comment
Kindly note that as a healthcare funder, we have a responsibility to our members to provide access to top quality healthcare, while ensuring the long-term sustainability of the scheme. We make decisions regarding the funding of medical procedures and services according to rigorous criteria to ensure that we meet both these objectives. Therefore, we have excluded certain healthcare services from cover, and breast reduction falls under these exclusions.
As discussed telephonically, all claims related to a General Scheme Exclusion will therefore also not be funded.
I am sorry that I cannot provide you with a different outcome to your query, however I hope that the information above will provide clarity on the matter.
Kind Regards
Dimakatso
Thank you for your comment
Kindly note that as a healthcare funder, we have a responsibility to our members to provide access to top quality healthcare, while ensuring the long-term sustainability of the scheme. We make decisions regarding the funding of medical procedures and services according to rigorous criteria to ensure that we meet both these objectives. Therefore, we have excluded certain healthcare services from cover, and breast reduction falls under these exclusions.
As discussed telephonically, all claims related to a General Scheme Exclusion will therefore also not be funded.
I am sorry that I cannot provide you with a different outcome to your query, however I hope that the information above will provide clarity on the matter.
Kind Regards
Dimakatso