ZH
Zeki H

1 reviews | Active since Jun 2014

12 Nov 2015, 14:57

Discovery Won't Pay Out

In May 2014 we were blessed with baby twin girls. However it was an emergency procedure due to the babies not growing which the Gynecologist was very concerned about and booked in my wife for a cesarean immediately. Everything by the grace of god went smoothly except for discovery of course. We were forced to pay the gynecologist and the anaesthetist ourselves although it should have been covered under PMB by Discovery themselves. After countless phone calls they refused to pay the full amount refusing that it was not an emergency and all the Dr's concerned were shocked by Discovery not paying. Since that time we have seen the pediatrician who has continually told us that he will get his money from Discovery as it was an EMERGENCY cesar so we should not worry about paying him. He was finally paid out the full amount for the operation. This has left me very furious with Discovery as we were not paid but left with a hefty bill. By Discovery paying the pediatrician they have now admitted liability for PMB therefore they should pay us the money back that we had to borrow to pay for the mentioned above. I urge anyone wanting to join Discovery to look elsewhere as the are ******.

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Replies (1)
Discovery Health
Discovery Health's reply23 Nov 2015, 09:31
Official
Hello zekihilmi,

Thank you for your comment.

Prescribed Minimum Benefits (PMBs) are legislated and every medical scheme in South Africa is required by law to fund a pre-defined list of approximately 270 conditions and 27 chronic conditions.
All medical schemes have to cover the costs related to the diagnosis treatment and care of any life threatening emergency medical condition.
There are certain requirements that must be met before a member can benefit in full from the Prescribed Minimum Benefits:
The medical condition must be part of the list of defined conditions for Prescribed Minimum Benefits.
The treatment needed must match the treatments included in the defined benefits.
The member must use a healthcare professional who Discovery Health has an arrangement with.

I have sent you an email which outlines the details regarding the funding of the claims.

Regards
Arthi