DISCOVERY NOT PAYING FOR AN EMERGENCY - DISPUTE of 9 MONTHS

NO ONE in the entire company can assist or want to assist me. I have been fighting since January with Discovery about an emergency claim. I have now been blacklisted because Discovery fails to pay this account.

Details are as follows: My son, Daniel Ross Louw, gets fever convulsions when he reaches 38+ degrees. I am currently on a network plan. The closest Network hospital in my area is Netcare, Kuilsriver. The hospital is 35.4 km from my home in Strand.

The closest ER facility to my house is Vergelegen Medi-Clinic.

On 8/1/2018 after MANY visits to the GP and MANY sick nights, my 1 year old son started throwing up in his sleep. I tried to wake him up. He was non-responsive. He then started shaking. Knowing my son and seeing that he had a fever of more than 38 degrees, I rushed him to the closest ER. He was there for 2 hours. They managed to bring down his fever eventually with a suppository.

After MANY phone calls and emails, and after MONTHS of telling my story I received an email this morning from Michael Pegram stating that my plan will NOT cover for either a PMB or a emergency situation. The same guy, promised me, more than a month ago, that he will sort out this problem for me within 5-7 working days. Now, every email after that is a new story. First he needed the medi-clinic to fill out forms, this after the ER doctor wrote 2 letters of motivation.

In March this year the EXACT same situation occured. Only this time, we were not so lucky to escape the convulsion. It did however occur in the GP's rooms and she immediately requested an ambulance. My son was also taken to Vergelegen ER to stabilise, and then transported to a network hospital.

NOW the claims department and MICHAEL PEGRAM is telling me that it was NOT an emergency situation.

Why then is my plan paying for the March incident. Why is my plan not covering an emergency situation like it stipulates? You can not tell me that this was not a medical emergency. This is a one year old child that gets fever convulsions. I'm very sure I don't have to tell you what the risks of a convulsion is, especially at his age.

It is my medical aids duty to pay this account. It seems like Discovery does not have staff with ANY medical knowledge. How can they tell me they won't cover it because it was not an emergency???????