Discovery refuses to pay a pre-approved procedure!?

<p>We have recently given birth by cesarean section. This procedure was pre-approved by Discovery, meaning we had peace of mind that we would be covered in full. Upon submitting the invoice to Discovery, we discovered that Discovery didn't even cover a third of the obstetrician's bill. This is despite us being on the Classic Priority Plan with 200% medical aid rate cover.</p> <p>The Obstetrician's in-theatre charges for this procedure is R13000 + R3000 for his assistant. I believe this to be a very reasonable rate as I've been quoted well in excess of R20 000 by comparative doctors. Discovery informed us that their medical aid rates for this procedure is only R3000. How can cover for serious surgery be this low?</p> <p>Further to this, Discovery no-where discloses what their medical aid rates for this procedure is, and refuses to point us to where they state that they only cover R3000 for this. Our pre-approved procedure nowhere stated that there will be a shortfall, or what the amount is that Discovery covers.</p> <p>I understand that we are liable for any shortfall, but my question is how we were supposed to know that Discovery only pays R3000 for this procedure? Nowhere does Discovery disclose what their cover entails upfront. If we missed this bit of information, please point me to it. If we knew, we could have made prior arrangements.</p> <p>I find it ludicrous that Discovery only covers such a minimal amount for such serious surgery. It feels like ******ion considering that we pay over R6000 per month for supposed premium cover.</p> <p> </p>