1 reviews | Active since Feb 2015
Discovery unaccountable for emergency operation
My fiance fell pregnant at the end of last year. At the time I had medical aid with Discovery for a number of years prior. As you would expect we rushed to get my partner onto Discovery Medical aid, only to find out we were hit with a 12 month waiver relating to the pregnancy.<br> I eventually got m y fiance onto the medical aid at the end of last month, but due to some paper work problems between PSG and Discovery the forms were finally submitted early February and we were told to put the start date of the 1st March.<br> Unfortunately last Monday at the 20 week scan we got the news that our child was diagnosed with holoprosencephaly which is a condition effecting the brain development of the child and is resulting in advice from our doctors to terminate the pregnancy.<br> This morning I had to book my fiance into Olivedale Hospital for an emergency C-Section operation to terminate the baby, however upon calling Discovery we were refused authorization, based on the fact that the procedure is classified as a birthing procedure and they will therefore not cover it. <br> Discover are discusting that in this state we have lost our child and have to pay 000's as Discovery have no accountability or care
Thank you for your comment.
I am truly sorry to hear about your unborn child's ill health. I understand this must be a very difficult time for both you and your fiance.
I investigated your query and confirm that during the application process, we underwrote your fiances application. Underwriting is a risk management tool that assists medical schemes in maintaining their long-term sustainability through the following:
o Protects the scheme against anti-selection. Anti-selection is when a member only uses a medical scheme when needed without paying the appropriate contribution
o Cuts down on potential costs
o Minimises abusive claiming behaviour.
As per the Medical Schemes Act, Medical Schemes are not allowed to decline membership to anyone. The Medical Schemes Act allows medical schemes to protect their risk pools using the following types of underwriting:
o Waiting periods
o The late-joiner penalty.
Based on the application we received, we correctly determined the waiting period imposed on your fiance's application. Also, we received the request to change the start date to 1 March from 1 February. I emailed you further details on your query.
Kind regards
Bruce
Thank you for your comment.
I am truly sorry to hear about your unborn child's ill health. I understand this must be a very difficult time for both you and your fiance.
I investigated your query and confirm that during the application process, we underwrote your fiances application. Underwriting is a risk management tool that assists medical schemes in maintaining their long-term sustainability through the following:
o Protects the scheme against anti-selection. Anti-selection is when a member only uses a medical scheme when needed without paying the appropriate contribution
o Cuts down on potential costs
o Minimises abusive claiming behaviour.
As per the Medical Schemes Act, Medical Schemes are not allowed to decline membership to anyone. The Medical Schemes Act allows medical schemes to protect their risk pools using the following types of underwriting:
o Waiting periods
o The late-joiner penalty.
Based on the application we received, we correctly determined the waiting period imposed on your fiance's application. Also, we received the request to change the start date to 1 March from 1 February. I emailed you further details on your query.
Kind regards
Bruce