Discovery Refuses to Pay

I joined Discovery Health on the 1 April 1999. Today 1 September 2018 will make this just close onto 19 years

Date Op: 30 August 2018 Place: Garden City Clinic, Johannnesburg

Operation costs, Hospitalisation & Medication - ZAR 40 000.00 Discovery contribution - ZAR 0.00

Reason they site: General Scheme Exclusion on the Smart Essential Plan Scheme

Over 18 months I tried every possible remedy to treat my obstructive breathing, but I reached a critical point where my Homeopath, GP and ENTs could no longer treat me with cortisone & steroids and we had to do the inevitable. Discovery has used the GSE as a way of refuting my claim and have further stated that the condition is not covered in the Prescribed Minimum Benefit of 1998 as grounds to deny my claim.

I would argue that PMB covers 'obstructive breathing and my obstructive breathing was caused by my inability to breathe through my nose (see ENT report and CT scan) due to multiple nasal polyps, the obstructive tissue was wreaking havoc with my ability to function at work, I was forced to breathe through my mouth, I had the onset of sleep apnea. On several occasions the severe nasal condition caused severe pressure on my inner ear causing me to lose my balance, a lost my balance whilst driving and almost caused an accident.

I have to pay an estimated ZAR 40 000! Discovery should do the right thing and live up to their stated values of honesty and integrity...not being able to breathe through your nose is obstructive and has a detrimental impact on health, well-being and livelihood.

Discovery’s refusal to pay is based on their inability to appreciate or acknowledge the facts that surround this matter.

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