Discovery rejects and won’t pay my claims

Last year October 2010, I went to visit a network doctor on my Essential Smart plan.

The GP requested a number of tests to be run but Discovery Health has refused to pay the pathology tests stating this is clearly not covered in my current plan.

A well meaning agent gave me call to explain that unfortunately the establishment cannot pay the expense but recommended that as a “future” recommendation to always call before hand to confirm if whatever test or consultation I intend on having is covered. (this is also problematic as there are all these nuances that they suddenly have as justifications when cases arise but are not necessarily shared or communicated before hand).

However I did the following; - Made myself fami**** with the limitations of the plan as far as I could (website and print material from Discovery) - Went to a recommended Discovery network GP (who should have known as well what limitations to apply for my plans and what tests not to recommend) - I explicitly inquired with the Network GP and pathologist on whether the tests would be covered.

The expense in question will be less than 10% of the amount I pay yearly to discovery on this plan and yet I am still being held liable for something that is a concerning loophole with the very network doctor that Discovery recommends.

Picking up the phone each time the doctor gives me instructions regarding a condition is really laughable. As a network doctor they should be held accountable to also learn the limitations of the medical aid plans (other medical aid plans have this in place so why can’t you) and not plunge consumers into debt without our consent.

Now I have to cough up double the money I already spend on my plan each month.

I would cancel my plan with discovery but it’s forced down our throats by corporate establishments. Little wonder why when they are just out to **** and plunder!